MEDICARE: RACHEL BONNEMA MD

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	207R00000X	Internal Medicine Physician	24674	NE
2	207R00000X	Internal Medicine Physician	MD428215	PA
3	207R00000X	Internal Medicine Physician	R8160	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R8160	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1861540551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL BONNEMA MD

Provider Business Mailing Address
First Line	:	P.O. BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:	214-648-2992
Fax Number	:	214-648-3700

Provider Business Practice Location Address
First Line	:	5959 HARRY HINES BLVD.
Second Line	:	MAIL CODE 9126
City	:	DALLAS
State	:	TX
Zip	:	75390
Country	:	US
Telephone Number	:	214-648-2992
Fax Number	:	214-648-3700

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	11/26/2018

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