Individual
LESLIE ANNE BENTINGANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 447-9749
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003734A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000681587
ANTHEM PROVIDER NUMBER
IN
05
—
200999040
—
IN
Enumeration date
09/22/2010
Last updated
03/12/2021
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