Provider Demographics
NPI:1710096755
Name:BENNETT, TIMOTHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM ROAD
Mailing Address - Street 2:CHILDREN'S MERCY HOSPITALS AND CLINICS
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-346-1343
Mailing Address - Fax:816-234-9336
Practice Address - Street 1:5520 COLLEGE BOULEVARD
Practice Address - Street 2:SUITE 480
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-696-5000
Practice Address - Fax:913-696-5005
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008011473207VM0101X
KS04-20677207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
625210OtherFIRSTGUARD
MO10865061OtherBCBS KANSAS CITY
KS100160620BMedicaid
160035366OtherRR MEDICARE
KS0736617AMedicare ID - Type Unspecified
MO201988045Medicare ID - Type UnspecifiedMO MEDICAID
C82787Medicare UPIN