Provider Demographics
NPI:1447298435
Name:BONELLI, JOSEPH E (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:BONELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7643
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0643
Mailing Address - Country:US
Mailing Address - Phone:971-663-2742
Mailing Address - Fax:970-667-0847
Practice Address - Street 1:615 FAIRHURST STREET
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-0000
Practice Address - Country:US
Practice Address - Phone:970-521-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
220009129OtherRAILROAD MEDICARE
CO01276039Medicaid
220009129OtherRAILROAD MEDICARE
CO11511Medicare ID - Type Unspecified
COC11511Medicare PIN