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NPI Code Detail

MEDICARE: DR. ANTHONY G BONITA PHD

MEDICARE: DR. ANTHONY G BONITA PHD
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
1103TC0700XClinical Psychologist6301015747MI

General Provider Information

NPI Number : 1932582608
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY G BONITA PHD
Provider Business Mailing Address
First Line : 235 WEALTHY ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-5247
Country : US
Telephone Number : 616-840-8000
Fax Number :
Provider Business Practice Location Address
First Line : 5191 ROSEWOOD DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-9137
Country : US
Telephone Number : 231-946-1979
Fax Number : 231-946-1984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2015
Last Update Date : 03/19/2024

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