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General NPI Number Information
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NPI Number | 1780645192
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Entity Type | Individual
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Provider Name | MARC A BONANNI DPM
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 990 W ANN ARBOR TRAIL SUITE 102
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City | PLYMOUTH
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State | MI
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Zip | 48170-1686
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Country | US
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Telephone | 734-572-1141
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Fax | 734-572-1142
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR IVE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001940
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License Number State | MI
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