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General NPI Number Information
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NPI Number | 1114084878
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Entity Type | Individual
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Provider Name | ANDREW BENNETT III M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 8750 WILSHIRE BLVD STE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2708
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Country | US
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Telephone | 310-689-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 4853 GALAXY PKWY SUITE I
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City | CLEVELAND
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State | OH
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Zip | 44128-5973
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Country | US
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Telephone | 216-831-9786
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Fax | 216-831-2425
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.090051
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A99787
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License Number State | CA
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