Basic Information
| Provider Information | |||||||||
| NPI: | 1790764405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENDER | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 E COUNTY LINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178852860 | ||||||||
| FaxNumber: | 3178852869 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 E COUNTY LINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178852860 | ||||||||
| FaxNumber: | 3178852869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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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 | 207R00000X | 01022089 | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100385900 | 05 | IN | MEDICAID |