Provider Demographics
NPI:1073519047
Name:BENNETT, WILLIAM MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13935 PLUMBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312
Mailing Address - Country:US
Mailing Address - Phone:586-939-9900
Mailing Address - Fax:586-939-8246
Practice Address - Street 1:13935 PLUMBROOK ROAD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312
Practice Address - Country:US
Practice Address - Phone:586-939-9900
Practice Address - Fax:586-939-8246
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002120213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI138116OtherCARE CHOICES
MI5501280OtherBCBSM
MIU85210OtherHEALTH ALLANCE PLAN
MI000000010955OtherCAPE HEALTH PLAN
MI200826048OtherUNITED HEALTHCARE
MI4618712OtherMOLINA
MI7928302OtherAETNA
MIP00459715OtherRAILROAD MEDICARE
MIDOL/WORKERS COMPOther611794800
MI4927665Medicaid
MIP00433820OtherRAILROAD MEDICARE
MI157017OtherGREAT LAKES HEALTH PLAN
MI540E020630OtherBCBSM DME SUPPLIER ID
MI024862OtherMIDWEST HEALTH PLAN
MI5209654Medicaid
MI200826048OtherUNITED HEALTHCARE
MI7928302OtherAETNA
MIDOL/WORKERS COMPOther611794800