Basic Information
| Provider Information | |||||||||
| NPI: | 1316125859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 ARKANSAS ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858321424 | ||||||||
| FaxNumber: | 7858321466 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 ARKANSAS ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858321424 | ||||||||
| FaxNumber: | 7858321466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2008 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 435062 | KS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.