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NPI Code Detail

MEDICARE: JOHN H BONK DPM

MEDICARE: JOHN H BONK DPM
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
1213ES0103XFoot & Ankle Surgery Podiatrist36-00-2361OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407851926
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN H BONK DPM
Provider Business Mailing Address
First Line : 1970 ROANOKE BLVD
Second Line :
City : SALEM
State : VA
Zip : 24153-6404
Country : US
Telephone Number : 540-982-2463
Fax Number : 540-224-1944
Provider Business Practice Location Address
First Line : 1970 ROANOKE BLVD
Second Line :
City : SALEM
State : VA
Zip : 24153-6404
Country : US
Telephone Number : 540-982-2463
Fax Number : 540-554-1944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/11/2007

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