Provider Demographics
NPI:1063472322
Name:BENTLEY, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:BENTLEY
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 1:6727 TAYLOR COURT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7708
Mailing Address - Country:US
Mailing Address - Phone:334-284-2800
Mailing Address - Fax:334-284-0438
Practice Address - Street 1:6727 TAYLOR COURT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7708
Practice Address - Country:US
Practice Address - Phone:334-284-2800
Practice Address - Fax:334-284-0438
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51083847OtherBLUE CROSS BLUE SHIELD
AL529102270Medicaid
AL000083847Medicare PIN
AL529102270Medicaid