Healthcare Provider Details

I. General information

NPI: 1598279879
Provider Name (Legal Business Name): LUKE WILLIAM BONHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVENUE, 3RD FLOOR, M372
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

733 N BROADWAY STE 147
BALTIMORE MD
21205-1832
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1968
  • Fax: 415-353-8741
Mailing address:
  • Phone: 410-955-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA189954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: