Individual
VICTOR D BENTINGANAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
407 N MEADOW ST, OTTERBEIN, IN 47970-0398
(765) 448-8000
(574) 583-2444
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002841A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000352596
ANTHEM PROVIDER NUMBER
IN
01
—
10893408
CAQH NUMBER
IN
05
—
200502560
—
IN
01
—
9396836
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
12/02/2020
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