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NPI Code Detail

MEDICARE: MR. BENNET GRAD DPM

MEDICARE: MR. BENNET GRAD DPM
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
1213E00000XPodiatrist36-00-2171-GOH

General Provider Information

NPI Number : 1497781397
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENNET GRAD DPM
Provider Business Mailing Address
First Line : 11584 SYMMES GATE LN
Second Line :
City : CINCINNATI
State : OH
Zip : 45249-2011
Country : US
Telephone Number : 513-489-7486
Fax Number : 513-227-2366
Provider Business Practice Location Address
First Line : 11584 SYMMES GATE LN
Second Line :
City : CINCINNATI
State : OH
Zip : 45249-2011
Country : US
Telephone Number : 513-227-2366
Fax Number : 513-489-7486
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 01/03/2024

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