MEDICARE: DR. MARTIN D BONNEY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	01047187A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50004094	OTHER	KY	PASSPORT GROUP # 50000548
2	50004275	OTHER	KY	PASSPORT GROUP # 1172544
3	000000060164	OTHER	KY	BCBS OF KY 12 DIGIT #
4	000000275811	OTHER	KY	BCBS OF KY 12 DIGIT #
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649275025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN D BONNEY JR. MD

Provider Business Mailing Address
First Line	:	1700 W SMITH VALLEY RD STE C1
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1589
Country	:	US
Telephone Number	:	317-300-4091
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W SMITH VALLEY RD STE C1
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1589
Country	:	US
Telephone Number	:	317-300-4091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/23/2021

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