Provider Demographics
NPI:1003884834
Name:BONJEAN, ALFRED LAMBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:LAMBERT
Last Name:BONJEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7335
Mailing Address - Country:US
Mailing Address - Phone:219-769-4835
Mailing Address - Fax:
Practice Address - Street 1:99 E 86TH AVE
Practice Address - Street 2:STE C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6267
Practice Address - Country:US
Practice Address - Phone:219-769-4835
Practice Address - Fax:219-769-5816
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024800A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000084012OtherANTHEM
IN100167330Medicaid
495210Medicare ID - Type Unspecified
IN100167330Medicaid