Provider Demographics
NPI:1306814538
Name:BENTINGANAN, VICTOR D JR (DO)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:D
Last Name:BENTINGANAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 N MEADOW ST
Practice Address - Street 2:
Practice Address - City:OTTERBEIN
Practice Address - State:IN
Practice Address - Zip Code:47970-0398
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:574-583-2444
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002841A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10893408OtherCAQH NUMBER
IN000000352596OtherANTHEM PROVIDER NUMBER
IN200502560Medicaid
IN9396836OtherPHCS PID NUMBER
IN815500I7Medicare PIN
IN9396836OtherPHCS PID NUMBER
ING33646Medicare UPIN
INP00172653Medicare PIN