Individual
CHARLES P BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
48798
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14559
DEAN
WI
05
—
34823000
—
WI
Enumeration date
01/10/2006
Last updated
12/04/2007
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