Provider Demographics
NPI:1518754936
Name:BENNETT, ALEXANDREA RANAE (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDREA
Middle Name:RANAE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:10122 E 10TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2664
Mailing Address - Country:US
Mailing Address - Phone:317-355-7356
Mailing Address - Fax:
Practice Address - Street 1:818 SE RICHLAND CIR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-3649
Practice Address - Country:US
Practice Address - Phone:515-664-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000506A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300115607Medicaid