Individual
GREGOR F BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2332 ALPINE AVE NW, GRAND RAPIDS, MI 49544-1955
(616) 391-6220
Mailing address
100 MICHIGAN ST NE, MC 109 ATTN JULIE L, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002104
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598712390
GROUP NPI
MI
Enumeration date
08/15/2006
Last updated
07/08/2007
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