MEDICARE: BENTLEY & BENTLEY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	MB019940	MI

General Provider Information

NPI Number	:	1225233562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTLEY & BENTLEY, P.C.

Provider Business Mailing Address
First Line	:	2532 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3663
Country	:	US
Telephone Number	:	517-787-5010
Fax Number	:	517-787-5014

Provider Business Practice Location Address
First Line	:	2532 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3663
Country	:	US
Telephone Number	:	517-787-5010
Fax Number	:	517-787-5014

Authorized Official
Title or Position	:	FAMILY PRACTICE MD
Name	:	MARY N BENTLEY
Credential	:	MD
Telephone Number	:	517-787-5010

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/10/2007

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