MEDICARE: FLAVIO FERNANDO BONILLA MD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35.156398	OH
2	208M00000X	Hospitalist Physician	35.156398	OH

General Provider Information

NPI Number	:	1174227425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLAVIO FERNANDO BONILLA MD, MS

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-7499
Fax Number	:	614-366-2360

Provider Business Practice Location Address
First Line	:	460 W 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:	614-293-7499
Fax Number	:	614-366-2360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	06/15/2026

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