Provider Demographics
NPI:1609922343
Name:YU, BENNETT W (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:W
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12018 DEER CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2863
Mailing Address - Country:US
Mailing Address - Phone:734-812-0889
Mailing Address - Fax:
Practice Address - Street 1:16761 SOUTHPARK CENTER
Practice Address - Street 2:FAMILY HEALTH & SURGICAL CENTER
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-878-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-03-22
Deactivation Date:2020-10-15
Deactivation Code:
Reactivation Date:2020-10-28
Provider Licenses
StateLicense IDTaxonomies
VA0101235693207RX0202X
FLME117476207RX0202X, 207RH0003X
MDD0039204207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184832040OtherGROUP NPI
FL14S7LOtherBCBS
MI1609922343Medicaid
MI3092113Medicaid
FLP01652182OtherRR MEDICARE
FL4575870OtherAETNA
MI1588778484OtherBCBSM - WMCC
FL009846800Medicaid
FL1224577OtherWELLCARE
FL370090OtherAVMED
MI1609922343Medicaid
FLIT686ZMedicare PIN
FL14S7LOtherBCBS
FL370090OtherAVMED