Healthcare Provider Details

I. General information

NPI: 1114857703
Provider Name (Legal Business Name): JOSEPH BONO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 28 MILE RD
WASHINGTON MI
48094-1204
US

IV. Provider business mailing address

5851 28 MILE RD
WASHINGTON MI
48094-1204
US

V. Phone/Fax

Practice location:
  • Phone: 586-212-1462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4704446956
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: