Michael Bennett
Individual provider Active NPI Peer Specialist · Newalla, OK
NPI 1295370336 · NPPES record last updated Nov 13, 2019
Key facts
- NPI
- 1295370336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 10624 S Choctaw Rd
Newalla, OK 74857-9315 - Phone
- (918) 771-1797
- NPI assigned
- Nov 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
10624 S Choctaw Rd
Newalla, OK 74857-9315
Mailing address
10624 S Choctaw Rd
Newalla, OK 74857-9315
Other providers in Newalla, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.