Individual
MICHAEL T BONTEKOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, PA-C
Contact information
Practice address
450 N ROXBURY DR STE 400, BEVERLY HILLS, CA 90210-4218
(243) 941-6104
(424) 394-1628
Mailing address
450 N ROXBURY DR STE 400, BEVERLY HILLS, CA 90210-4218
(424) 394-1610
(424) 394-1628
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA16231
CA
363AM0700X
Medical Physician Assistant
Primary
PA16231
CA
Other
Enumeration date
09/02/2006
Last updated
11/02/2020
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