Basic Information
| Provider Information | |||||||||
| NPI: | 1790761823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONNIN | ||||||||
| FirstName: | ARTURO | ||||||||
| MiddleName: | JOSE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8039 WASHINGTON VILLAGE DRIVE | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374358999 | ||||||||
| FaxNumber: | 9374354211 | ||||||||
| Practice Location | |||||||||
| Address1: | 8039 WASHINGTON VILLAGE DRIVE | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454583859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374358999 | ||||||||
| FaxNumber: | 9374354211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 35 063692 | OH | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 0893476 | 05 | OH | MEDICAID |