Provider Demographics
NPI:1871695924
Name:BONTIA, KAREN M (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BONTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 275
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4320
Mailing Address - Country:US
Mailing Address - Phone:972-253-4270
Mailing Address - Fax:972-401-0458
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:STE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2219
Practice Address - Country:US
Practice Address - Phone:972-253-4270
Practice Address - Fax:972-401-0458
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN80782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1484134OtherCIGNA
ME432319099Medicaid
ME7090704OtherAETNA
ME098056OtherANTHEM BLUE SHIELD
ME1484134OtherCIGNA
MEME2068Medicare ID - Type Unspecified