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Contact Information

MARC A BONANNI, DPM
990 W ANN ARBOR TRAIL
SUITE 102
PLYMOUTH, MI48170-1686
 Phone: 734-572-1141
 Fax: 734-572-1142
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MARC A BONANNI · (Male)

NPI # 1780645192
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 03/28/2006
Last updated 01/23/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • MI License # 5901001940
  • MI Medicaid 4134728
  • MI Medicaid 4144617
  • MI Other 4858215680 BCBSM PIN
Hospital affiliation(s)
  • SAINT JOSEPH MERCY LIVINGSTON HOSPITAL - (Acute Care)
    620 BYRON RD
    HOWELL, MI 48843
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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