Healthcare Provider Details

I. General information

NPI: 1982072385
Provider Name (Legal Business Name): MR. ALEXANDER BENNATAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 11TH AVE S APT 469
NASHVILLE TN
37203-4010
US

IV. Provider business mailing address

320 11TH AVE S APT 469
NASHVILLE TN
37203-4010
US

V. Phone/Fax

Practice location:
  • Phone: 224-565-6134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number242T00000X
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: