Provider Demographics
NPI:1891709663
Name:BENNETT, RICHARD M III (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BENNETT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:1270 N POST RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4254
Practice Address - Country:US
Practice Address - Phone:317-895-6095
Practice Address - Fax:317-895-6195
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042286A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370OtherGROUP MEDICAID NUMBER
IN200003540Medicaid
IN000000091691OtherANTHEM PIN NUMBER
IN1487680518OtherGROUP NPI
IN100194370OtherGROUP MEDICAID NUMBER
IN340015560OtherMEDICARE RAILROAD
INF84233Medicare UPIN
IN069340OMedicare PIN
IN677730LLLMedicare PIN
IN340015559OtherMEDICARE RAILROAD
IN200003540Medicaid