Provider Demographics
NPI:1578659884
Name:BENNINGER, BRUCE W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:BENNINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0530
Mailing Address - Country:US
Mailing Address - Phone:765-521-1217
Mailing Address - Fax:765-521-1218
Practice Address - Street 1:1000 N. 16TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1217
Practice Address - Fax:765-521-1218
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01040456207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200095460Medicaid
ING44664Medicare UPIN
IN220890IMedicare PIN