Individual
DR. MARC A BONANNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
990 W ANN ARBOR TRAIL, SUITE 102, PLYMOUTH, MI 48170-1686
(734) 572-1141
(734) 572-1142
Mailing address
24 FRANK LLOYD WRIGHT DR IVE, J2000, ANN ARBOR, MI 48105
(734) 747-6766
(734) 222-3100
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901001940
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4134728
—
MI
05
—
4144617
—
MI
01
—
4858215680
BCBSM PIN
MI
Enumeration date
03/28/2006
Last updated
01/23/2025
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