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General NPI Number Information
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NPI Number | 1164607909
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Entity Type | Organization
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Legal Business Name | MICHELLE R BONNESS, M.D. S.C.
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 20611 WATERTOWN RD SUITE D
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City | WAUKESHA
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State | WI
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Zip | 53186-1871
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Country | US
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Telephone | 262-782-7021
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Fax | 262-782-8738
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Provider Business Mailing Address
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Address Line | 20611 WATERTOWN RD SUITE D
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City | WAUKESHA
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State | WI
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Zip | 53186-1871
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Country | US
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Telephone | 262-782-7021
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. JULIE A QUIRK
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Credential |
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Telephone | 262-782-7021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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