Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 01024800A | IN |
NPI | 1003884834 |
---|---|
Provider Name | Alfred Lambert Bonjean |
First Address | Merrillville, IN 46410-7335 |
Second Address | Merrillville, IN 46410-6267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 09/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000084012 | ANTHEM (01) | |
100167330 | (05) | IN |
B28828 | (02) |