Basic Information
| Provider Information | |||||||||
| NPI: | 1053487421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNINGER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | CLEVELAND CLINIC | ||||||||
| Address2: | 9500 EUCLID AVENUE, A-71 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164446686 | ||||||||
| FaxNumber: | 2164459409 | ||||||||
| Practice Location | |||||||||
| Address1: | CLEVELAND CLINIC | ||||||||
| Address2: | 9500 EUCLID AVENUE, A-71 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164446686 | ||||||||
| FaxNumber: | 2164459409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 4301052477 | MI | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 055213 | OH | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | MB052477 | 01 | CHAMPUS-CHAMPUS | OTHER | 189443510 | 05 | MI | MEDICAID | MB052477 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER | 700H262260 | 01 | BLUE CROSS-BLUE CROSS | OTHER |