Provider Demographics
NPI:1629186689
Name:BONNETTE, JAMES CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLAYTON
Last Name:BONNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 STONEMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1683
Mailing Address - Country:US
Mailing Address - Phone:615-491-4517
Mailing Address - Fax:
Practice Address - Street 1:4520 STONEMEADOW CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1683
Practice Address - Country:US
Practice Address - Phone:615-491-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34025207R00000X
MI2061679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine