Provider Demographics
NPI:1801689047
Name:BONILLA-SALMERON, ANTHONY ULISSES (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ULISSES
Last Name:BONILLA-SALMERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3039 TRAPPERS COVE TRL APT 3A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8514
Mailing Address - Country:US
Mailing Address - Phone:213-429-8090
Mailing Address - Fax:
Practice Address - Street 1:965 WILSON RD RM A233
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-6410
Practice Address - Country:US
Practice Address - Phone:517-353-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43510551542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry