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General NPI Number Information
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NPI Number | 1003852161
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Entity Type | Individual
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Provider Name | ELIZA A. BENNETT M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 20 S PARK ST OB/GYN CLINIC
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City | MADISON
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State | WI
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Zip | 53715-1348
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Country | US
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Telephone | 608-287-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SOUTH PARK SUITE 555 UNIVERSITY OF WISCONSIN DEPARTMENT OF OB/GYN
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City | MADISON
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State | WI
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Zip | 53715-1349
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Country | US
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Telephone | 608-287-2494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 51413-20
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License Number State | WI
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