Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Michael Robert Bonisa, PA-C

Individual provider Vascular & Interventional Radiology Physician · NPI 1760444723

Mr. Michael Robert Bonisa, PA-C is a Physician Assistant in Charlotte, North Carolina. Qualified in 1999, 27 years ago. Practices with Mecklenburg Radiology Associates PA, a 94-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
27
Licensed in
NC
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3623 Latrobe Dr Ste 216
Charlotte, NC 28211
Phone: (704) 332-1291
Fax: (704) 332-5206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 000102829 (NC)
Vascular & Interventional Radiology Physician Taxonomy 2085R0204X · Licence 000102829 (NC)

Record details

NPI number1760444723
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 5, 2006
Last updated in NPPESFebruary 3, 2023
Certification dateOctober 1, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice Mecklenburg Radiology Associates Pa — 94 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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