Individual
DR. JOSHUA LEITCH BONKOWSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
Mailing address
295 CHIPETA WAY, PEDS ADMIN, SALT LAKE CITY, UT 84108-1220
(801) 587-7575
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4979065-1205
UT
2084N0400X
Neurology Physician
4979065-1205
UT
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
4979065-1205
UT
Other
Enumeration date
05/23/2006
Last updated
10/28/2021
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