Individual
DR. THOMAS OMAR BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8679 CONNECTICUT ST, STE A, MERRILLVILLE, IN 46410-6383
(219) 769-9022
(219) 769-1918
Mailing address
8679 CONNECTICUT ST, STE A, MERRILLVILLE, IN 46410-6383
(219) 769-9022
(219) 769-1918
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01030607A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100167860
—
IN
Enumeration date
05/27/2005
Last updated
03/26/2014
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