Provider Demographics
NPI:1861426769
Name:BENOIT-ROCK, LYONEL (MD)
Entity type:Individual
Prefix:
First Name:LYONEL
Middle Name:
Last Name:BENOIT-ROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LORRAINE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5600
Mailing Address - Country:US
Mailing Address - Phone:620-663-7595
Mailing Address - Fax:620-728-2036
Practice Address - Street 1:1600 N LORRAINE
Practice Address - Street 2:SUITE 202
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5600
Practice Address - Country:US
Practice Address - Phone:620-663-7595
Practice Address - Fax:620-728-2036
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0800265207Q00000X
KS08-00265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H95387Medicare UPIN
KS103312Medicare ID - Type Unspecified