Provider Demographics
NPI:1639259260
Name:BONGIORNO, FRANK (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:BONGIORNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3830 PACKARD ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2051
Mailing Address - Country:US
Mailing Address - Phone:866-645-5578
Mailing Address - Fax:888-528-0919
Practice Address - Street 1:3830 PACKARD ST
Practice Address - Street 2:SUITE 180
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2051
Practice Address - Country:US
Practice Address - Phone:866-645-5578
Practice Address - Fax:888-528-0919
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301060835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI770002984OtherTRAVELERS
MI4281939Medicaid
MIN38410001Medicare PIN
MI770002984OtherTRAVELERS
MIN38400001Medicare PIN