Provider Demographics
NPI:1982072385
Name:BENNATAN, ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:BENNATAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 11TH AVE S
Mailing Address - Street 2:APT 469
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 11TH AVE S
Practice Address - Street 2:APT 469
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4010
Practice Address - Country:US
Practice Address - Phone:224-565-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN242T00000X242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist