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
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053670307 NPPES
Wisconsin MEDICAID 100079068

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