Individual
DR. JONATHAN GABRIEL BONCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12901 W NATIONAL AVE, NEW BERLIN, WI 53151-4063
(262) 787-5200
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 389-2377
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
69595
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079068
—
WI
Enumeration date
05/07/2012
Last updated
11/24/2021
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