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Individual

AMANDA R BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
1150 E SHERMAN BLVD STE 1175, MUSKEGON, MI 49444-1885
(231) 672-6740
(231) 672-6749
Mailing address
PO BOX 776982, CHICAGO, IL 60677-6982
(866) 611-1512
(231) 728-4789

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101022048
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1861874190
MI
Enumeration date
06/23/2015
Last updated
11/10/2025
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