Provider Demographics
NPI:1164607909
Name:MICHELLE R BONNESS, M.D. S.C.
Entity Type:Organization
Organization Name:MICHELLE R BONNESS, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-782-7021
Mailing Address - Street 1:20611 WATERTOWN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-782-7021
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-782-7021
Practice Address - Fax:262-782-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty