Provider Demographics
NPI:1588179584
Name:SHERYL BENTZLEY DPM PC
Entity Type:Organization
Organization Name:SHERYL BENTZLEY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BENTZLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-979-3438
Mailing Address - Street 1:967 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2659
Mailing Address - Country:US
Mailing Address - Phone:248-979-3438
Mailing Address - Fax:
Practice Address - Street 1:967 BROOKLAWN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2659
Practice Address - Country:US
Practice Address - Phone:248-979-3438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001424213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty