Provider Demographics
NPI:1285984005
Name:BONETTI LUGO, ANA HILDA (MD,)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:HILDA
Last Name:BONETTI LUGO
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:HILDA
Other - Last Name:BONETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-226-3186
Mailing Address - Fax:901-227-3206
Practice Address - Street 1:255 BAPTIST BLVD STE 402
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2006
Practice Address - Country:US
Practice Address - Phone:662-244-2550
Practice Address - Fax:662-244-2553
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25447207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease