Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 4301117526 | MI |
NPI | 1396128021 |
---|---|
Provider Name | Michael Bonnette |
First Address | Livonia, MI 48152-5007 |
Second Address | Livonia, MI 48152-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 21/07/2020 |