Individual
RYAN BONEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4630 VISTULA RD, MISHAWAKA, IN 46544-4000
(574) 647-1900
(574) 647-7206
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01077161A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001038702
ANTHEM
IN
05
—
201375950
—
IN
Enumeration date
04/18/2013
Last updated
03/30/2021
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