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NPI Code Detail

MEDICARE: THEODORE BONNER MD

MEDICARE: THEODORE BONNER 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
1207R00000XInternal Medicine Physician29912WI
2207Q00000XFamily Medicine Physician29912WI

General Provider Information

NPI Number : 1992852891
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE BONNER MD
Provider Business Mailing Address
First Line : 2555 N MARTIN LUTHER KING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2709
Country : US
Telephone Number : 414-372-8080
Fax Number :
Provider Business Practice Location Address
First Line : 8200 W SILVER SPRING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-2552
Country : US
Telephone Number : 414-760-3900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 03/07/2023

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Directions to “ THEODORE BONNER MD” Practice Location

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