Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301036844 | MI |
NPI | 1093737413 |
---|---|
Provider Name | Dr. Michael L Bennett |
First Address | Grand Rapids, MI 49503-5731 |
Second Address | Grand Rapids, MI 49503-5732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 27/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4377234 | (05) | MI |