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General NPI Number Information
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NPI Number | 1285851246
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Entity Type | Individual
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Provider Name | CHRISTINE O'CONNOR BONHOMME M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 5101 WILLOW SPRINGS RD
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City | LA GRANGE
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State | IL
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Zip | 60525-2600
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Country | US
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Telephone | 708-245-8975
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Fax | 708-245-5615
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Provider Business Mailing Address
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Address Line | 174 WILLOW BLVD
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1643
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Country | US
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Telephone | 708-839-1862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 49212020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME85965
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01054779A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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