Provider Demographics
NPI:1144694571
Name:PINE KNOB URGENT CARE PLLC
Entity type:Organization
Organization Name:PINE KNOB URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BONZHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:810-262-9020
Mailing Address - Street 1:6310 SASHABAW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6310 SASHABAW RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2270
Practice Address - Country:US
Practice Address - Phone:810-262-9020
Practice Address - Fax:810-715-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care