MEDICARE: MICHAEL ERNEST BENNETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	200400806	NC
2	2085R0202X	Diagnostic Radiology Physician	CDRH.0044660	CO
3	2085N0700X	Neuroradiology Physician	44660	CO
4	2085R0202X	Diagnostic Radiology Physician	25IA12793300	NJ
5	2085R0202X	Diagnostic Radiology Physician	DR.0044660	CO
6	2085R0202X	Diagnostic Radiology Physician	339051	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083698385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ERNEST BENNETT MD

Provider Business Mailing Address
First Line	:	1746 COLE BLVD
Second Line	:	STE 150
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3267
Country	:	US
Telephone Number	:	303-914-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	938 BANNOCK ST
Second Line	:	STE. 300
City	:	DENVER
State	:	CO
Zip	:	80204-4028
Country	:	US
Telephone Number	:	303-914-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	12/29/2025

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