Provider Demographics
NPI:1881705382
Name:BONKOWSKI, MARTA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:BONKOWSKI
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 1:17222 HOSPITAL BLVD STE 242
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-754-3565
Mailing Address - Fax:352-606-2811
Practice Address - Street 1:17222 HOSPITAL BLVD STE 242
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-754-3565
Practice Address - Fax:352-606-2711
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018708200Medicaid
MI295153610Medicaid