Provider Demographics
NPI:1932296555
Name:BONDI, LAUREL A (DPM)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:BONDI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-525-4778
Mailing Address - Fax:816-525-5761
Practice Address - Street 1:224 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-525-4778
Practice Address - Fax:816-525-5761
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO513213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO302393608Medicaid
MO302393616Medicaid
MO11293033OtherBCBS PROVIDER NUMBER
MO480010965OtherRAILROAD MEDICARE
MO11293033OtherBCBS PROVIDER NUMBER
MO302393616Medicaid
MO302393608Medicaid
MO480010965OtherRAILROAD MEDICARE