Provider Demographics
NPI:1700084779
Name:BENNION, ALKA B (MD)
Entity Type:Individual
Prefix:
First Name:ALKA
Middle Name:B
Last Name:BENNION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4444 N 32ND ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3956
Mailing Address - Country:US
Mailing Address - Phone:602-747-7026
Mailing Address - Fax:602-957-1997
Practice Address - Street 1:4444 N 32ND ST
Practice Address - Street 2:SUITE 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3956
Practice Address - Country:US
Practice Address - Phone:602-747-7026
Practice Address - Fax:602-957-1997
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ40303207V00000X
OH35-089260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3733775Medicaid
Z162949OtherMEDICAR PTAN