MEDICARE: MR. MICHAEL-DAVID BENDOR M.S.

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	104100000X	Social Worker	6801010012	MI
2	1041C0700X	Clinical Social Worker	6801010012	MI

General Provider Information

NPI Number	:	1487820304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL-DAVID BENDOR M.S.

Provider Business Mailing Address
First Line	:	PO BOX 981246
Second Line	:
City	:	SUPERIOR TOWNSHIP
State	:	MI
Zip	:	48198-1246
Country	:	US
Telephone Number	:	734-484-1628
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 STOMMEL RD
Second Line	:
City	:	SUPERIOR TOWNSHIP
State	:	MI
Zip	:	48198-9634
Country	:	US
Telephone Number	:	734-484-1628
Fax Number	:

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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