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Individual

KATHLEEN D. BOHNKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
11123 PARKVIEW PLAZA DR, SUITE 106, FORT WAYNE, IN 46845-1707
(260) 672-6550
(260) 672-6559
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01049000A
IN
208000000X
Pediatrics Physician
Primary
01049000A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000200308
ANTHEM
IN
01
00002092719 02
UNITED HEALTHCARE
01
12182
PHYSICIANS HEALTH PLAN
IN
05
200342340
IN
01
3937240021
MEDICARE DMEPOS
IN
01
3937240024
MEDICARE DMEPOS
IN
01
7762243
AETNA
Enumeration date
12/05/2005
Last updated
11/15/2022
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