Individual
BENNETT L WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2060 E PARIS AVE SE STE 200, GRAND RAPIDS, MI 49546-6113
(616) 285-1377
(616) 285-1154
Mailing address
5555 GLENWOOD HILLS PKWY SE STE 2, GRAND RAPIDS, MI 49512-2091
(616) 940-2662
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
5101008161
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
5101008161
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4535360-11
—
MI
05
—
4609992-11
—
MI
05
—
4610008-11
—
MI
05
—
5212687-11
—
MI
01
—
555410027
BCBSM
MI
Enumeration date
04/28/2006
Last updated
05/06/2021
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