Healthcare Provider Details

I. General information

NPI: 1740284470
Provider Name (Legal Business Name): RONALD A BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 E STATE ROAD 44
FRANKLIN IN
46131-9199
US

IV. Provider business mailing address

990 E STATE ROAD 44
FRANKLIN IN
46131-9199
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-8474
  • Fax: 317-736-6040
Mailing address:
  • Phone: 317-736-8474
  • Fax: 317-736-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01032752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: