Provider Demographics
NPI:1760486674
Name:BONAR, SUSAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:BONAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11237 NALL AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1655
Mailing Address - Country:US
Mailing Address - Phone:913-469-3690
Mailing Address - Fax:913-469-3692
Practice Address - Street 1:11237 NALL AVE STE 130
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1655
Practice Address - Country:US
Practice Address - Phone:913-469-3690
Practice Address - Fax:913-469-3692
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29549207XX0004X
KS0429549207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
202879427OtherHUMANA
MO21386021OtherBCBS OF KC
MO202879427OtherCIGNA
MO5778210OtherAETNA
202879727OtherGREAT WEST HEALTHCARE
MO202879427OtherCOVENTRY
MO202879427OtherADVANTRA
MO207754219Medicaid
202879427OtherHUMANA
202879727OtherGREAT WEST HEALTHCARE
KST007342AMedicare ID - Type UnspecifiedKS MEDICARE
MO21386021OtherBCBS OF KC
MO5778210OtherAETNA