Individual
MYLA NICOLE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1911 CHESTER BLVD, RICHMOND, IN 47374-1212
(765) 962-4872
(765) 935-8913
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 962-4872
(765) 935-8913
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01070339A
IN
208200000X
Plastic Surgery Physician
35.097053
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000738583
ANTHEM
IN
05
—
0051083
—
OH
05
—
201040990
—
IN
Enumeration date
05/23/2007
Last updated
01/09/2015
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