Provider Demographics
NPI:1942524020
Name:BONDICI, ANAMARIA BIANCA (MD)
Entity Type:Individual
Prefix:
First Name:ANAMARIA
Middle Name:BIANCA
Last Name:BONDICI
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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:616-685-8200
Mailing Address - Fax:616-685-8201
Practice Address - Street 1:310 LAFAYETTE AVE SE
Practice Address - Street 2:STE 410
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-685-8200
Practice Address - Fax:616-685-8202
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108845207R00000X, 207RI0200X
OH35.099977207R00000X
IN01076222A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201338600Medicaid
INP01691180OtherRR MEDICARE
IN000001013450OtherANTHEM- BMG GASTROENTEROLOGY ELKHART
OH0071154Medicaid
IN000000986424OtherANTHEM BMG CENTENNIAL NEIGHBORHOOD HEALTH CENTER
IN236040168Medicare PIN
INP01691180OtherRR MEDICARE
IN000000986424OtherANTHEM BMG CENTENNIAL NEIGHBORHOOD HEALTH CENTER