Provider Demographics
NPI:1497781397
Name:GRAD, BENNET (DPM)
Entity Type:Individual
Prefix:MR
First Name:BENNET
Middle Name:
Last Name:GRAD
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 1:11584 SYMMES GATE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2011
Mailing Address - Country:US
Mailing Address - Phone:513-489-7486
Mailing Address - Fax:513-227-2366
Practice Address - Street 1:11584 SYMMES GATE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2011
Practice Address - Country:US
Practice Address - Phone:513-227-2366
Practice Address - Fax:513-489-7486
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2171-G213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GR0538162Medicare ID - Type Unspecified