Provider Demographics
NPI:1053358663
Name:BENENATI, ANTHONY V (DPM)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:V
Last Name:BENENATI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27593 HARPER
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-779-6140
Mailing Address - Fax:586-779-9865
Practice Address - Street 1:27593 HARPER
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-779-6140
Practice Address - Fax:586-779-9865
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001624213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E017630OtherBC DME SUPPLIER
4855013430OtherBC
MI2970406Medicaid
MI4855055560OtherBLUE CROSS PIN NUMBER
4855013430OtherBC
0P21960001Medicare PIN
MI540E017630OtherBC DME SUPPLIER