Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 5101012872 | MI |
NPI | 1346234770 |
---|---|
Provider Name | Peter Louis Bono |
First Address | Southfield, MI 48075-4825 |
Second Address | Southfield, MI 48075-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H39925 | (02) | MI |