Provider Demographics
NPI:1093927980
Name:SEAKS, BONNIE J (PA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:SEAKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:D128 W FEE HALL
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-355-3503
Mailing Address - Fax:517-432-1167
Practice Address - Street 1:E CIRCLE DR OLIN HEALTH CENTER
Practice Address - Street 2:UNIVERSITY PHYSICIANS OFFICE
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-353-9101
Practice Address - Fax:517-355-0332
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant