Provider Demographics
NPI:1073512422
Name:BONGIORNO, PHILIP F (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:BONGIORNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-1657
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:600 SW COLLEGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1684
Practice Address - Country:US
Practice Address - Phone:785-270-5115
Practice Address - Fax:785-270-7309
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431284208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200326220AMedicaid
KS104704Medicare ID - Type Unspecified
KS200326220AMedicaid