Provider Demographics
NPI:1841278157
Name:BENNERMAN, MONIQUE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:MICHELLE
Last Name:BENNERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:MICHELLE
Other - Last Name:FORSKIN-BENNERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1005 DR. D. B. TODD BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208
Mailing Address - Country:US
Mailing Address - Phone:615-327-5998
Mailing Address - Fax:615-327-6733
Practice Address - Street 1:1005 DR. D. B. TODD BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208
Practice Address - Country:US
Practice Address - Phone:615-327-5998
Practice Address - Fax:615-327-6733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3326189Medicaid
TN3326189Medicaid
TNI22821Medicare UPIN