Provider Demographics
NPI:1558575829
Name:BONACCI, JEFFREY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:BONACCI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:315 E WARWICK DR
Mailing Address - Street 2:STE 3
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-463-6699
Mailing Address - Fax:989-466-2574
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:STE 3
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-463-6699
Practice Address - Fax:989-466-2574
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-06-25
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Provider Licenses
StateLicense IDTaxonomies
MI4301083704208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery