Provider Demographics
NPI:1124032974
Name:ROSSETTO, BENNIE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:JOSEPH
Last Name:ROSSETTO
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 1:155 THREE MILE DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3035
Mailing Address - Country:US
Mailing Address - Phone:406-752-9006
Mailing Address - Fax:
Practice Address - Street 1:66 CLAREMONT ST
Practice Address - Street 2:B
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3518
Practice Address - Country:US
Practice Address - Phone:406-751-5980
Practice Address - Fax:406-751-5981
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine