Dr. Jonathan Gabriel Bonchak
Dermatologist
12901 W National Ave
New Berlin
, Wisconsin 53151-4063
Dr. Jonathan Gabriel Bonchak
Dermatologist
12901 W National Ave
New Berlin
, Wisconsin 53151-4063
(414) 389-2377
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Dr. Jonathan Gabriel Bonchak
- 3301 W Forest Home Ave
- Milwaukee, WI
- Zip : 53215-2843
- Phone : (414) 389-2377
Second Address
- Dr. Jonathan Gabriel Bonchak
- 12901 W National Ave
- New Berlin, WI
- Zip : 53151-4063
- Phone : (262) 787-5200
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 69595 | WI |
National Provider Identifier
| NPI | 1053670307 |
|---|---|
| Provider Name | Dr. Jonathan Gabriel Bonchak |
| First Address | Milwaukee, WI 53215-2843 |
| Second Address | New Berlin, WI 53151-4063 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/05/2012 |
| Last Update Date | 24/11/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 100079068 | (05) | WI |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.