Individual
MICHELLE D BONTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
417 SW 117TH AVE, 2ND FLOOR, PORTLAND, OR 97225-5924
(503) 216-9400
(503) 216-9499
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD25129
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233462
—
OR
01
—
P00207043
RR MEDICARE - PH&S
OR
Enumeration date
06/25/2006
Last updated
10/15/2020
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