Healthcare Provider Details

I. General information

NPI: 1053513184
Provider Name (Legal Business Name): MARTA BONKOWSKI, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 W BRISTOL RD
FLINT MI
48507-2921
US

IV. Provider business mailing address

5105 W BRISTOL RD
FLINT MI
48507-2921
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-0822
  • Fax: 810-733-5567
Mailing address:
  • Phone: 810-733-0822
  • Fax: 810-733-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301056493
License Number StateMI

VIII. Authorized Official

Name: DR. MARTA Z. BONKOWSKI
Title or Position: PHYSICIAN
Credential:
Phone: 810-733-0822