Provider Demographics
NPI:1982677399
Name:STAMATIS, BONNIE (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:STAMATIS
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 1:5077 WATERFORD DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0705
Mailing Address - Country:US
Mailing Address - Phone:440-365-4800
Mailing Address - Fax:440-284-9909
Practice Address - Street 1:5077 WATERFORD DR STE 305
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-0705
Practice Address - Country:US
Practice Address - Phone:440-365-4800
Practice Address - Fax:440-284-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341882027OtherCOMMERCIAL CARRIERS
OH36D0958263OtherCLIA
OH110176964OtherRAILROAD MEDICARE
OH0908281Medicaid
OH000000141297OtherANTHEM
OH36D0958263OtherCLIA
OHF55531Medicare UPIN