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NPI Code Detail

MEDICARE: MR. JUAN MIGUEL BONETTI M.D.

MEDICARE: MR. JUAN MIGUEL BONETTI 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
1208000000XPediatrics Physician16583SC

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 : 1487657870
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUAN MIGUEL BONETTI M.D.
Provider Business Mailing Address
First Line : 313 MAIN ST
Second Line : SUITE B
City : GREENWOOD
State : SC
Zip : 29646-2757
Country : US
Telephone Number : 864-388-0301
Fax Number : 864-388-0648
Provider Business Practice Location Address
First Line : 113 LINER DR
Second Line :
City : GREENWOOD
State : SC
Zip : 29646-2311
Country : US
Telephone Number : 864-941-8170
Fax Number : 864-388-1718
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 09/18/2013

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