Individual
THOMAS W BENNINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4121 DUTCHMANS LN, SUITE #101, LOUISVILLE, KY 40207-4707
(502) 897-2531
(502) 896-5863
Mailing address
2700 STANLEY GAULT PKWY, STE 129, LOUISVILLE, KY 40223-5132
(502) 253-4917
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
22073
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000247202
ANTHEM
—
01
—
50000083
PASSPORT
—
05
—
64220734
—
KY
Enumeration date
08/12/2005
Last updated
04/21/2016
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