MEDICARE: DR. IGNATIUS HENRY BAFFOE-BONNIE M.D.

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	207RI0200X	Infectious Disease Physician	ME84089	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1417912197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGNATIUS HENRY BAFFOE-BONNIE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 91177
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33804-1177
Country	:	US
Telephone Number	:	863-682-7246
Fax Number	:	863-682-5566

Provider Business Practice Location Address
First Line	:	202 PARKVIEW PL
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4548
Country	:	US
Telephone Number	:	863-682-7246
Fax Number	:	863-682-5566

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	01/24/2008

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