MEDICARE: ROBERT M BONAMINIO D.O.

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	207V00000X	Obstetrics & Gynecology Physician	036094083	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427001486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M BONAMINIO D.O.

Provider Business Mailing Address
First Line	:	2850 W. 95TH ST
Second Line	:	SUITE 103
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2735
Country	:	US
Telephone Number	:	708-636-9205
Fax Number	:	708-229-6075

Provider Business Practice Location Address
First Line	:	2850 W. 95TH ST
Second Line	:	SUITE 103
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2735
Country	:	US
Telephone Number	:	708-636-9205
Fax Number	:	708-229-6075

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/18/2014

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