MEDICARE: STEVEN R BONOMO MD

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	208600000X	Surgery Physician	036098541	IL

General Provider Information

NPI Number	:	1861478893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN R BONOMO MD

Provider Business Mailing Address
First Line	:	1900 W POLK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-5210
Fax Number	:	312-864-9633

Provider Business Practice Location Address
First Line	:	1900 W POLK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-5210
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	04/22/2021

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