Provider Demographics
NPI:1285752998
Name:BENDER, BRETT BARRY (DO)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:BARRY
Last Name:BENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5701 BOW POINTE DR STE 215
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5400
Mailing Address - Country:US
Mailing Address - Phone:248-620-3376
Mailing Address - Fax:248-620-3379
Practice Address - Street 1:5701 BOW POINTE DR STE 215
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5400
Practice Address - Country:US
Practice Address - Phone:248-620-3376
Practice Address - Fax:248-620-3379
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016359207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0756319375OtherBLUE CROSS BLUE SHIELD
MI0756319375OtherBLUE CARE NETWORK
MIMI1867002Medicare PIN