Basic Information
| Provider Information | |||||||||
| NPI: | 1073519047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13935 PLUMBROOK ROAD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869399900 | ||||||||
| FaxNumber: | 5869398246 | ||||||||
| Practice Location | |||||||||
| Address1: | 13935 PLUMBROOK ROAD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869399900 | ||||||||
| FaxNumber: | 5869398246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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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 | 213ES0103X | 5901002120 | MI | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213E00000X | 5901002120 | MI | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 138116 | 01 | MI | CARE CHOICES | OTHER | 5501280 | 01 | MI | BCBSM | OTHER | U85210 | 01 | MI | HEALTH ALLANCE PLAN | OTHER | 000000010955 | 01 | MI | CAPE HEALTH PLAN | OTHER | 200826048 | 01 | MI | UNITED HEALTHCARE | OTHER | 4618712 | 01 | MI | MOLINA | OTHER | 7928302 | 01 | MI | AETNA | OTHER | P00459715 | 01 | MI | RAILROAD MEDICARE | OTHER | DOL/WORKERS COMP | 01 | MI | 611794800 | OTHER | 4927665 | 05 | MI | MEDICAID | P00433820 | 01 | MI | RAILROAD MEDICARE | OTHER | 157017 | 01 | MI | GREAT LAKES HEALTH PLAN | OTHER | 540E020630 | 01 | MI | BCBSM DME SUPPLIER ID | OTHER | 024862 | 01 | MI | MIDWEST HEALTH PLAN | OTHER | 5209654 | 05 | MI | MEDICAID |