Healthcare Provider Details

I. General information

NPI: 1225233562
Provider Name (Legal Business Name): BENTLEY & BENTLEY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 SPRING ARBOR RD
JACKSON MI
49203-3663
US

IV. Provider business mailing address

2532 SPRING ARBOR RD
JACKSON MI
49203-3663
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-5010
  • Fax: 517-787-5014
Mailing address:
  • Phone: 517-787-5010
  • Fax: 517-787-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMB019940
License Number StateMI

VIII. Authorized Official

Name: MARY N BENTLEY
Title or Position: FAMILY PRACTICE MD
Credential: MD
Phone: 517-787-5010