Individual
MIKAL NASIR BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2100 ERWIN RD, DURHAM, NC 27710-0001
(919) 684-8111
Mailing address
4101 N ROXBORO ST, DURHAM, NC 27704-2121
(919) 684-8111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
NC
Other
Enumeration date
04/16/2007
Last updated
10/26/2007
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