Provider Demographics
NPI:1053374165
Name:BONZELAAR, WILLIAM BARRY (MD032354)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BARRY
Last Name:BONZELAAR
Suffix:
Gender:M
Credentials:MD032354
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7724
Mailing Address - Country:US
Mailing Address - Phone:616-392-8035
Mailing Address - Fax:616-392-7404
Practice Address - Street 1:904 S WASHINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7724
Practice Address - Country:US
Practice Address - Phone:616-392-8035
Practice Address - Fax:616-392-7404
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIWB049408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI207Q00000XOtherTAXONOMY
MI3325725 10Medicaid
MI3325725 10Medicaid
MIA78010Medicare UPIN