Bonneville, Mark W

Bonneville, Mark W is an individual health care provider with primary practice located at 1013 Hart Blvd , Monticello MN 55362-8575. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Bonneville, Mark W can be contacted via phone (763) 271-2386.

Contact Information

Primary practice address
1013 Hart Blvd Monticello MN 55362-8575
Fax: (763) 271-2890
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 35582 Minnesota

Profile Details

NPI number 1336129626
LBN Legal business name Bonneville, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 20th, 2006
Last updated Jan 15th, 2009 - about 15 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 1336129626 NPPES
Minnesota MEDICAID 069268900

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