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General NPI Number Information
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NPI Number | 1801866397
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Entity Type | Individual
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Provider Name | ANTHONY ARLO BENNETT MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 1899 ORCHARD LAKE RD SUITE 104
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City | SYLVAN LAKE
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State | MI
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Zip | 48320-1774
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Country | US
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Telephone | 248-894-8019
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Fax | 248-693-4632
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Provider Business Mailing Address
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Address Line | 441 FRANKLIN WRIGHT BLVD
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City | LAKE ORION
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State | MI
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Zip | 48362-1585
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Country | US
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Telephone | 248-894-8019
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Fax | 248-693-4632
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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 | AB063302
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License Number State | MI
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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 | 036112710
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License Number State | IL
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