IndividualActive
Jason Bennett, M.D.
NPI 1295757631 · Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician · Grand Rapids, MI
Provider details
- NPI number
- 1295757631
- Entity type
- Individual
- Primary specialty
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- 4301076635 (MI)
Specialties & taxonomies
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianPrimary207VF0040XLicense 4301076635 (MI)
Allopathic & Osteopathic Physicians
Practice location
770 Kenmoor Ave Se Ste 301
Grand Rapids, MI 49546-8621
Phone: (616) 290-1876
Fax: (616) 290-1877
Approximate (ZIP-level) locationGet directions
Mailing address
770 Kenmoor Ave Se Ste 301
Grand Rapids, MI 49546-8621
Registry dates
- Enumerated
- 2006-07-24
- Last updated
- 2026-06-05
- Certified
- 2026-06-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.