Provider Demographics
NPI:1801866397
Name:BENNETT, ANTHONY ARLO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ARLO
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:441 FRANKLIN WRIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1585
Mailing Address - Country:US
Mailing Address - Phone:248-894-8019
Mailing Address - Fax:248-693-4632
Practice Address - Street 1:1899 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1774
Practice Address - Country:US
Practice Address - Phone:248-894-8019
Practice Address - Fax:248-693-4632
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB0633022085R0202X
IL0361127102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAB063302OtherLICENSE
MI700H219330OtherBLUE CROSS
MI3009301771OtherBCBSM
MIMI3594001OtherPTAN
MI3009301771OtherBCBSM