Provider Demographics
NPI:1487820304
Name:BENDOR, MICHAEL-DAVID (MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL-DAVID
Middle Name:
Last Name:BENDOR
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 981246
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-1246
Mailing Address - Country:US
Mailing Address - Phone:734-484-1628
Mailing Address - Fax:
Practice Address - Street 1:2820 STOMMEL RD
Practice Address - Street 2:
Practice Address - City:SUPERIOR TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48198-9634
Practice Address - Country:US
Practice Address - Phone:734-484-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801010012104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker