Individual
DR. LEO M. BONAVENTURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4199 GATEWAY BLVD, SUITE 2900, NEWBURGH, IN 47630-8940
(812) 842-4530
(812) 842-4535
Mailing address
4199 GATEWAY BLVD, SUITE 2900, NEWBURGH, IN 47630-8940
(812) 842-4530
(812) 842-4535
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
01022970
IN
207VG0400X
Gynecology Physician
01022970
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000328110
ANTHEM
IN
01
—
000000580355
ANTHEM
IN
Enumeration date
08/02/2006
Last updated
01/25/2011
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