Healthcare Provider Details

I. General information

NPI: 1134090269
Provider Name (Legal Business Name): ERIKA BONATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 BEECH ST STE 1100
CLARE MI
48617-1476
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-386-9911
  • Fax:
Mailing address:
  • Phone: 844-832-5279
  • Fax: 989-633-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013372
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: