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NPI Code Detail

MEDICARE: DR. BENNETT BENITO DESADIER M.D.

MEDICARE:  DR. BENNETT BENITO DESADIER  M.D.
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
1174400000XSpecialist024318IN

General Provider Information

NPI Number : 1972507879
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENNETT BENITO DESADIER M.D.
Provider Business Mailing Address
First Line : 2020 W 86TH ST
Second Line : STE 305
City : INDIANAPOLIS
State : IN
Zip : 46260-1931
Country : US
Telephone Number : 317-334-1692
Fax Number : 317-334-1693
Provider Business Practice Location Address
First Line : 2020 W 86TH ST
Second Line : STE 305
City : INDIANAPOLIS
State : IN
Zip : 46260-1931
Country : US
Telephone Number : 317-334-1692
Fax Number : 317-334-1693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 07/08/2007

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Directions to “ DR. BENNETT BENITO DESADIER M.D.” Practice Location

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