Bonchak, Jonathan Gabriel
Bonchak, Jonathan Gabriel is an individual health care provider with primary practice located at 12901 W National Ave , New Berlin WI 53151-4063. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Bonchak, Jonathan Gabriel can be contacted via phone (262) 787-5200.Contact Information
Primary practice address
12901 W National Ave
New Berlin WI 53151-4063
Phone: (262) 787-5200
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 69595 | Wisconsin |
Profile Details
| NPI number | 1053670307 |
|---|---|
| LBN Legal business name | Bonchak, Jonathan Gabriel |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 7th, 2012 |
| Last updated | Nov 24th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053670307 | NPPES |
| Wisconsin | MEDICAID | 100079068 |
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