Individual
JASON BONFIGLIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
800 RIVERSIDE DR, WAUPACA, WI 54981-1943
(715) 258-1000
Mailing address
405 BISHOPS WAY UNIT 629, BROOKFIELD, WI 53005-6261
(414) 588-3405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100135023
—
WI
Enumeration date
10/08/2020
Last updated
11/06/2023
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