Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 055213 | OH |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301052477 | MI |
NPI | 1053487421 |
---|---|
Provider Name | Michael S. Benninger |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 20/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
189443510 | (05) | MI |
700H262260 | BLUE CROSS-BLUE CROSS (01) | |
A79327 | (02) | |
MB052477 | CHAMPUS-CHAMPUS (01) | |
MB052477 | COMMERCIAL-COMMERCIAL NUMBER (01) |