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NPI Code Detail

MEDICARE: ERIC BENTLAGE

MEDICARE: ERIC BENTLAGE
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
1367500000XCertified Registered Nurse Anesthetist4704263932MI

General Provider Information

NPI Number : 1710257365
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC BENTLAGE
Provider Business Mailing Address
First Line : 170 BAYOU ST
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-9101
Country : US
Telephone Number : 248-515-0647
Fax Number :
Provider Business Practice Location Address
First Line : 580 W COLLEGE AVE
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-2705
Country : US
Telephone Number : 906-228-9440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2012
Last Update Date : 01/12/2012

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Directions to “ ERIC BENTLAGE ” Practice Location

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