Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001424 | MI |
NPI | 1336338896 |
---|---|
Provider Name | Sheryl Lyn Bentzley |
First Address | Southfield, MI 48075-2421 |
Second Address | Southfield, MI 48075-2421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 26/08/2009 |