Provider Demographics
NPI:1972920452
Name:BONK INTERNAL MEDICINE,INC.
Entity type:Organization
Organization Name:BONK INTERNAL MEDICINE,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONK-CHANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PAC
Authorized Official - Phone:901-761-1850
Mailing Address - Street 1:5575 POPLAR AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0821
Mailing Address - Country:US
Mailing Address - Phone:901-761-1850
Mailing Address - Fax:
Practice Address - Street 1:5575 POPLAR AVE STE 504
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0821
Practice Address - Country:US
Practice Address - Phone:901-761-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN277261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care