Individual
DR. CYNTHIA BONTRAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2120 RIETH BLVD, SUITE A, GOSHEN, IN 46526-5843
(574) 875-5126
(574) 875-1874
Mailing address
PO BOX 1887, ELKHART GENERAL PHYSICIAN SERVICES, ELKHART, IN 46515-1887
(574) 389-0542
(574) 522-8505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042854A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000484891
ANTHEM BLUE CROSS & BLUE SHIELD
IN
01
—
000000567803 EGH
ANTHEM BLUE CROSS & BLUE SHIELD
IN
05
—
100325640
—
IN
Enumeration date
01/24/2006
Last updated
12/11/2009
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