Basic Information
| Provider Information | |||||||||
| NPI: | 1063905495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENTLEY | ||||||||
| FirstName: | SUSANNE | ||||||||
| MiddleName: | GIANA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 ESKENAZI AVE | ||||||||
| Address2: | FIFTH THIRD BANK BUILDING, 5TH FL | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46202 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5515 W 38TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178803838 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LL51979 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 51979 | SC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RA0401X | 02006786A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.