Provider Demographics
NPI:1730135146
Name:BONEBRAKE, FRANK C (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:C
Last Name:BONEBRAKE
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 1:6567 E CARONDELET DR
Mailing Address - Street 2:STE 515
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6158
Mailing Address - Country:US
Mailing Address - Phone:520-885-1402
Mailing Address - Fax:520-722-5887
Practice Address - Street 1:2817 NEW PINERY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9240
Practice Address - Country:US
Practice Address - Phone:608-742-4131
Practice Address - Fax:608-742-0362
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ64612207RP1001X
WI27567-020207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2475OtherDEAN HEALTH INSURANCE
WI31571900Medicaid
WI31571900Medicaid
WI028774150Medicare PIN
WI000257085Medicare PIN
WI290005576Medicare PIN
WI019854340Medicare PIN