Provider Demographics
NPI:1508084310
Name:PLINE, BONNIE JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:JEAN
Last Name:PLINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JEAN
Other - Last Name:ARENDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1042 S. RAVENNA RD.
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:MI
Mailing Address - Zip Code:49451
Mailing Address - Country:US
Mailing Address - Phone:231-853-2519
Mailing Address - Fax:231-853-2838
Practice Address - Street 1:1042 S. RAVENNA RD.
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451
Practice Address - Country:US
Practice Address - Phone:231-853-2519
Practice Address - Fax:231-853-2838
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3142001OtherMEDICARE