Provider Demographics
NPI:1265579015
Name:SENDZICKI, BONNIE JOAN (DO)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JOAN
Last Name:SENDZICKI
Suffix:
Gender:F
Credentials:DO
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 337
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ME
Mailing Address - Zip Code:04040
Mailing Address - Country:US
Mailing Address - Phone:207-583-2399
Mailing Address - Fax:207-583-2399
Practice Address - Street 1:81 BLACKGUARD ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:ME
Practice Address - Zip Code:04088
Practice Address - Country:US
Practice Address - Phone:207-583-2399
Practice Address - Fax:207-583-2399
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#1306204D00000X
ME1306208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37145Medicare UPIN