Provider Demographics
NPI:1992018261
Name:SUZANNE MP BENNETT DO PC
Entity Type:Organization
Organization Name:SUZANNE MP BENNETT DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-843-2300
Mailing Address - Street 1:18275 N 59TH AVE BLDG H, 144
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-843-2300
Mailing Address - Fax:602-843-2310
Practice Address - Street 1:18275 N 59TH AVE BLDG H, STE. 144
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-843-2300
Practice Address - Fax:602-843-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3258174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG63285Medicare UPIN
AZ139094Medicare PIN