MEDICARE: B S BONYO DO & ASSOCIATES INC

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	207Q00000X	Family Medicine Physician	34007305B	OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154543213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B S BONYO DO & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1569 VERNON ODOM BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4089
Country	:	US
Telephone Number	:	330-867-7544
Fax Number	:	330-867-7434

Provider Business Practice Location Address
First Line	:	1569 VERNON ODOM BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4089
Country	:	US
Telephone Number	:	330-867-7544
Fax Number	:	330-867-7434

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENSON S. BONYO
Credential	:	DO
Telephone Number	:	330-867-7544

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	04/30/2024

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