Healthcare Provider Details

I. General information

NPI: 1184713026
Provider Name (Legal Business Name): BONNIE LEE HOUFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N JORDAN AVE
BLOOMINGTON IN
47405-3190
US

IV. Provider business mailing address

600 N JORDAN AVE
BLOOMINGTON IN
47405-3190
US

V. Phone/Fax

Practice location:
  • Phone: 812-856-5259
  • Fax: 812-855-4628
Mailing address:
  • Phone: 812-856-5259
  • Fax: 812-855-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number01046691
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: