Provider Demographics
NPI:1053513184
Name:MARTA BONKOWSKI, M.D., P.C.
Entity type:Organization
Organization Name:MARTA BONKOWSKI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BONKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-733-0822
Mailing Address - Street 1:5105 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2921
Mailing Address - Country:US
Mailing Address - Phone:810-733-0822
Mailing Address - Fax:810-733-5567
Practice Address - Street 1:5105 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2921
Practice Address - Country:US
Practice Address - Phone:810-733-0822
Practice Address - Fax:810-733-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881705382OtherINDIVIDUAL NPI NUMBER
MI1881705382OtherINDIVIDUAL NPI NUMBER