Provider Demographics
NPI:1114035847
Name:BENNHOFF, DAVID F (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:BENNHOFF
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 1:805 COLUMBIA RD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1487
Mailing Address - Country:US
Mailing Address - Phone:440-808-9469
Mailing Address - Fax:440-808-9532
Practice Address - Street 1:805 COLUMBIA RD
Practice Address - Street 2:SUITE #111
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1487
Practice Address - Country:US
Practice Address - Phone:440-808-9469
Practice Address - Fax:440-808-9532
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031416B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256413Medicaid
OH0363114Medicare PIN
OH0256413Medicaid