JOHN P BONAVIA


Address: 1317 W Grand Ave, Port Washington, WI 53074-2075
Phone: 2622686998

JOHN P BONAVIA (NPI# 1497716880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497716880
Entity Type Individual
Full Name JOHN P BONAVIA
Credential MD
Practice Address 1317 W Grand Ave
Port Washington
WI 53074-2075
Mailing Address 4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale
WI 53212-1082
Practice Telephone 2622686998
Mailing Telephone 4149612750
Enumeration Date 2006-03-28
Last Update Date 2012-06-05
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine 23729 WI Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WI 30656000 05

Office Location

Street Address 1317 W GRAND AVE
City PORT WASHINGTON
State WI
Zip Code 53074-2075

Providers in the same location

NPI Name Taxonomy Address Enumeration
1134677669 Bonnie Halper Counselor 1317 W Grand Ave, Port Washington, WI 53074-2075 2016-09-13
1104373323 Marcy Drummy Counselor 1317 W Grand Ave, Port Washington, WI 53074-2075 2016-09-06
1497049969 Forefront Dermatology, S.c. Dermatology 1317 W Grand Ave, Suite 5, Port Washington, WI 53074 2011-06-02
1982840757 Ebonie Gray Registered Nurse 1317 W Grand Ave, Port Washington, WI 53074-2075 2008-12-30
1003955972 Neal Z. Potash Social Worker 1317 W Grand Ave, Port Washington, WI 53074-2075 2007-02-06
1144232125 Kim Marie Rasmussen Occupational Therapist 1317 W Grand Ave, Port Washington, WI 53074-2075 2006-08-11
1821005406 Jacqueline Weeden Social Worker 1317 W Grand Ave, Port Washington, WI 53074-2075 2006-08-03
1770599953 Jeffrey Joseph Bongiorno Podiatrist 1317 W Grand Ave, Port Washington, WI 53074-2075 2006-07-31
1154365336 Teresa Lin Braun Speech-Language Pathologist 1317 W Grand Ave, Port Washington, WI 53074-2075 2006-06-16
1215971627 David Arthur Peterson Physical Therapist 1317 W Grand Ave, Port Washington, WI 53074-2075 2006-06-15
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1962045864 Heather Kay Brede Technician 857 Ashley Avenue, Port Washington, WI 53074 2019-10-23
1780062034 Amanda Zitzer Specialist/Technologist 1037 S Spring Street, Apt 257, Port Washington, WI 53074 2015-05-07
1639507643 Kelly Mulder Occupational Therapy Assistant 138 E Prospect St, Port Washington, WI 53074 2013-10-30
1235310921 Susan Ann Dobberpuhl Occupational Therapist 306 N Sprint St, Port Washington, WI 53074 2007-11-21
1245444736 Lee B Raffel Social Worker 3632 E Norport Drive, Port Washington, WI 53074 2007-05-10
1023143708 Joshua E Leute Dentist 1317 West Grand Avenue, Port Washington, WI 53074 2007-02-22
1578633806 Robert Andrew Kortsch Dentist 457 W Grand Ave, Port Washington, WI 53074 2006-11-08
1538256409 Daniel P Witkowski Dentist 1612 N Wisconsin St, Port Washington, WI 53074 2006-10-10
1477584878 Francine L Cosner Obstetrics & Gynecology 1777 W Grand Avenue, Port Washington, WI 53074 2006-07-05
1013953926 Port Washington Podiatry Inc Podiatrist 1317 W Grand Avenue, Port Washington Podiatry, Port Washington, WI 53074 2006-06-20
Find all providers in zip 53074

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1679801344 Raymond J. Voulo Family Medicine 71 Longview Rd, Port Washington, NY 11050-3039 2009-11-18
1437483120 Danielle D Roberts Family Medicine 403-1 Main Street, Port Washington, NY 11040 2009-09-28
1790966968 Scott Rex, Md, LLC. Family Medicine 620 Port Washington Blvd, Port Washington, NY 11050-3714 2007-11-16
1427188473 Premier Physician Services Family Medicine 14 Vanderventer Ave Ste 138, Suite 130-138, Port Washington, NY 11050-3737 2007-03-07
1457493694 Gabrielle C. Young-lyon Family Medicine 23 Dolphin Grn Apt E2b, Port Washington, NY 11050-3161 2007-02-13
1750429007 Raymond Webster Family Medicine 2 Hampton Ct, Port Washington, NY 11050-3021 2007-02-01
1649318981 Raymond A Webster Family Medicine 2 Cow Neck Rd, Port Washington, NY 11050-1712 2007-02-01
1760568851 Gerald Zupnick Family Medicine 15 Hampton Rd, Port Washington, NY 11050-3008 2006-10-31
1801819180 Farzad Tabibzadeh Family Medicine 22 S Maryland Ave, Port Washington, NY 11050-2913 2006-07-26
1053375246 Scott L Rex Family Medicine 6 Bernard St, Port Washington, NY 11050-2902 2006-04-14
Find all providers in PORT WASHINGTON

Competitor

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City PORT WASHINGTON
Zip Code 53074

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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