Individual
LESLIE BENNETT-GRANATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
451 HIDDEN MEADOWS DR, SUITE 120, HILLSDALE, MI 49242-9812
(517) 437-0010
(517) 437-0319
Mailing address
12 E BACON ST, HILLSDALE, MI 49242-1616
(517) 437-7010
(517) 437-7627
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301075087
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0120145
PHP
MI
01
—
080160720
MEDICARE RAILROAD
MI
01
—
0803000492
BCBS
MI
01
—
103257
GLHP
MI
05
—
4210900
—
MI
01
—
P107546
BCN
MI
Enumeration date
07/08/2005
Last updated
02/14/2017
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