Provider Demographics
NPI:1003852161
Name:BENNETT, ELIZA A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTH PARK SUITE 555
Mailing Address - Street 2:UNIVERSITY OF WISCONSIN DEPARTMENT OF OB/GYN
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1349
Mailing Address - Country:US
Mailing Address - Phone:608-287-2494
Mailing Address - Fax:
Practice Address - Street 1:20 S PARK ST
Practice Address - Street 2:OB/GYN CLINIC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1348
Practice Address - Country:US
Practice Address - Phone:608-287-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51413-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology