Organization
MICHELE L BENNETT MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELE L BENNETT MD (PHYSICIAN/PRESIDENT)
(307) 673-6100
Entity
Organization
Contact information
Practice address
248 W WORKS ST, SHERIDAN, WY 82801-4213
(307) 673-6100
(307) 673-1975
Mailing address
248 W WORKS ST, SHERIDAN, WY 82801-4213
(307) 673-6100
(307) 673-1975
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05809001
BLUE CROSS/BLUE SHIELD
WY
Enumeration date
12/17/2007
Last updated
11/29/2012
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