Charles P Bennett, MD
Individual provider Active NPI Anesthesiology Physician · Fond Du Lac, WI
NPI 1821077801 · NPPES record last updated Dec 4, 2007
Key facts
- NPI
- 1821077801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 48798 (WI)
- Practice address
- 430 E Division St
Fond Du Lac, WI 54935-4560 - Phone
- (920) 926-8340
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesiologists Associated PC | Past | Accepting new patients | |
| Agnesian Healthcare Inc | Past | Accepting new patients | |
| Anesthesiologists Associated PC | Anesthesiology | Past | Accepting new patients |
| Specialists in Pain Management, PLLC Dba Spine & Pain Associates | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 48798 | WI | Yes |
Addresses
Primary practice location
430 E Division St
Fond Du Lac, WI 54935-4560
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34823000 | Medicaid | WI | |
| 14559 | Other | WI | DEAN |
Other providers in Fond Du Lac, WI
- Jeremy M. Bell
- Todd J Bell
- Sara Ann Beltz
- Rachel Rae Bending
- Erin Clark Benedict
- Scott Blanton Bennion
- Elizabeth S Bensen
- Josh Bruce Berceau
- Elizabeth J Berenz
- Melissa Dawn Berggren
All providers in Fond Du Lac, WI · Anesthesiology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2007. 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.