Provider Demographics
NPI:1053487421
Name:BENNINGER, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BENNINGER
Suffix:
Gender:M
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:CLEVELAND CLINIC
Mailing Address - Street 2:9500 EUCLID AVENUE, A-71
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-6686
Mailing Address - Fax:216-445-9409
Practice Address - Street 1:CLEVELAND CLINIC
Practice Address - Street 2:9500 EUCLID AVENUE, A-71
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6686
Practice Address - Fax:216-445-9409
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052477207Y00000X
OH055213207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB052477OtherCHAMPUS-CHAMPUS
MI189443510Medicaid
MB052477OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262260OtherBLUE CROSS-BLUE CROSS
700H262260OtherBLUE CROSS-BLUE CROSS
A79327Medicare UPIN