Organization
BONAVENTURA REPRODUCTIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEO BONAVENTURA MD (OWNER)
(317) 814-4570
Entity
Organization
Contact information
Practice address
11725 N ILLINOIS ST, STE 345, CARMEL, IN 46032-3008
(317) 814-4570
(317) 814-4517
Mailing address
11725 N ILLINOIS ST, STE 345, CARMEL, IN 46032-3008
(317) 814-4570
(317) 814-4517
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000328110
ANTHEM
IN
01
—
000000580355
ANTHEM
IN
Enumeration date
05/04/2007
Last updated
09/10/2010
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