Individual
GARRETT BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR SUITE 110, FORT WAYNE, IN 46845
(260) 425-6780
(260) 425-6615
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
306317
LA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01082465A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028176
—
IN
Enumeration date
06/04/2012
Last updated
05/05/2023
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