Provider Demographics
NPI:1164576286
Name:BONNIE STAMATIS, MD INC
Entity Type:Organization
Organization Name:BONNIE STAMATIS, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMATIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-365-4800
Mailing Address - Street 1:860 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6542
Mailing Address - Country:US
Mailing Address - Phone:440-365-4800
Mailing Address - Fax:
Practice Address - Street 1:5077 WATERFORD DR STE 305
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-0705
Practice Address - Country:US
Practice Address - Phone:440-365-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908281Medicaid
OH0737484Medicare PIN