MEDICARE: MICHELE BENNINGTON

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	237700000X	Hearing Instrument Specialist	17001413A	IN

General Provider Information

NPI Number	:	1164817656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE BENNINGTON

Provider Business Mailing Address
First Line	:	7720 LIMA RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-2163
Country	:	US
Telephone Number	:	260-482-8503
Fax Number	:

Provider Business Practice Location Address
First Line	:	7720 LIMA RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-2163
Country	:	US
Telephone Number	:	260-482-8503
Fax Number	:

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	12/21/2016

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Directions to “ MICHELE BENNINGTON ” Practice Location

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