1053513184 NPI number — MARTA BONKOWSKI, M.D., P.C.

Table of content: (NPI 1053513184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053513184 NPI number — MARTA BONKOWSKI, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTA BONKOWSKI, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053513184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5105 W BRISTOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-733-0822
Provider Business Mailing Address Fax Number:
810-733-5567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5105 W BRISTOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-733-0822
Provider Business Practice Location Address Fax Number:
810-733-5567
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BONKOWSKI
Authorized Official First Name:
MARTA
Authorized Official Middle Name:
Z.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
810-733-0822

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301056493 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881705382 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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