Individual
RICHARD CHARLES BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31157 WOODWARD AVE, ROYAL OAK, MI 48073-0996
(248) 336-0123
(248) 336-3190
Mailing address
31157 WOODWARD AVE, ROYAL OAK, MI 48073-0996
(248) 336-0123
(248) 336-3190
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301080053
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06273
BLUE CROSS BLUE SHIELD
MI
01
—
P00761477
RAILROAD MEDICARE
MI
Enumeration date
05/10/2007
Last updated
06/02/2015
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