Michael T Bontekoe, MS, PA-C
Physician Assistant, Medical in Beverly Hills, CA. Individual provider (NPI-1).
NPI number1124120902
StatusActive
Last updated in NPPESNov 2, 2020
Details
- NPI
- 1124120902
- Entity type
- Individual (NPI-1)
- Name
- Michael T Bontekoe
- Credential
- MS, PA-C
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 2, 2006
- Certification date
- Oct 30, 2020
- Last updated
- Nov 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA16231 | CA | Yes |
| 207N00000X | Dermatology | PA16231 | CA |
Practice location
450 N Roxbury Dr Ste 400Beverly Hills, CA 90210-4218
Phone 243-941-6104 · Fax 424-394-1628
Mailing address
450 N Roxbury Dr Ste 400Beverly Hills, CA 90210-4218
Phone 424-394-1610 · Fax 424-394-1628
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