Healthcare Provider Details

I. General information

NPI: 1942739461
Provider Name (Legal Business Name): CHARLES H. BONISKE M.D, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

5319 W HILLSDALE AVE
VISALIA CA
93291-5118
US

V. Phone/Fax

Practice location:
  • Phone: 559-679-9677
  • Fax:
Mailing address:
  • Phone: 559-732-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES H BONISKE
Title or Position: PRESIDENT
Credential: MD
Phone: 559-679-9677