MEDICARE: MICHAEL BONSAVER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP5585	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01724911	OTHER	AZ	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5858852	OTHER	AZ	AETNA

General Provider Information

NPI Number	:	1336552132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BONSAVER FNP

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	625 N 6TH ST STE 300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-3066
Country	:	US
Telephone Number	:	602-406-8222
Fax Number	:	602-604-4722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	04/15/2026

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