Individual
MR. MARK W BONNEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1013 HART BLVD, MONTICELLO, MN 55362-8575
(763) 271-2386
(763) 271-2890
Mailing address
12955 30TH AVE N, PLYMOUTH, MN 55441-2738
(763) 553-1070
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35582
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069268900
—
MN
Enumeration date
01/20/2006
Last updated
01/15/2009
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