Individual
DR. KENNETH G BENNET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
155 E BRUSH HILL RD, ELMHURST MEMORIAL HOSPITAL, ELMHURST, IL 60126-5658
(630) 941-4562
Mailing address
23685 NETWORK PL, CHICAGO, IL 60673-1236
(847) 677-6410
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
36116708
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002233091
BLUE SHIELD PROVIDER
IL
05
—
036116708
—
IL
Enumeration date
08/30/2006
Last updated
07/03/2013
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