Provider Demographics
NPI:1255435798
Name:BENNET, JOHN II (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BENNET
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26040 DETROIT RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2481
Mailing Address - Country:US
Mailing Address - Phone:440-871-1717
Mailing Address - Fax:440-871-3098
Practice Address - Street 1:26040 DETROIT RD
Practice Address - Street 2:SUITE 7
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2481
Practice Address - Country:US
Practice Address - Phone:440-871-1717
Practice Address - Fax:440-871-3098
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35 056333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0875236Medicaid
OH0875236Medicaid