Provider Demographics
NPI:1255399051
Name:BONNEMA, ALBERT HENRY JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:HENRY
Last Name:BONNEMA
Suffix:JR
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 1:2171 HUNTERS RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-7088
Mailing Address - Country:US
Mailing Address - Phone:210-722-7412
Mailing Address - Fax:
Practice Address - Street 1:2110 LEITER RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3598
Practice Address - Country:US
Practice Address - Phone:937-384-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0679032083C0008X, 2083P0901X
OH35-06-7903-B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine