MEDICARE: PATRICK BENNETT

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1649886631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK BENNETT

Provider Business Mailing Address
First Line	:	2773 HAMPSHIRE RD APT 11
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2541
Country	:	US
Telephone Number	:	530-517-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	12395 MCCRACKEN RD STE E
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2946
Country	:	US
Telephone Number	:	216-662-8696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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