MEDICARE: MICHAELYN BENNETT

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	171M00000X	Case Manager/Care Coordinator

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144370651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELYN BENNETT

Provider Business Mailing Address
First Line	:	600 ST PAUL AVE
Second Line	:	STE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2038
Country	:	US
Telephone Number	:	213-482-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 ST PAUL AVE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2038
Country	:	US
Telephone Number	:	213-482-6400
Fax Number	:	213-482-6408

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	05/13/2013

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