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NPI Code Detail

MEDICARE: BONITA H. GAWEL P.A.C.

MEDICARE: BONITA H. GAWEL P.A.C.
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
1363A00000XPhysician Assistant5601003552MI

General Provider Information

NPI Number : 1508896762
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONITA H. GAWEL P.A.C.
Provider Business Mailing Address
First Line : PO BOX 427
Second Line :
City : HILLMAN
State : MI
Zip : 49746-0427
Country : US
Telephone Number : 989-742-4583
Fax Number : 989-742-4298
Provider Business Practice Location Address
First Line : 15774 STATE STREET
Second Line :
City : HILLMAN
State : MI
Zip : 49746-8818
Country : US
Telephone Number : 989-742-4583
Fax Number : 989-742-4298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 07/19/2010

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