Healthcare Provider Details

I. General information

NPI: 1992018261
Provider Name (Legal Business Name): SUZANNE MP BENNETT DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE BLDG H, STE. 144
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

18275 N 59TH AVE BLDG H, 144
GLENDALE AZ
85308-1260
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-2300
  • Fax: 602-843-2310
Mailing address:
  • Phone: 602-843-2300
  • Fax: 602-843-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3258
License Number StateAZ

VIII. Authorized Official

Name: DR. SUZANNE BENNETT
Title or Position: PRESIDENT
Credential: DO
Phone: 602-843-2300