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1558327015

NPI Code Detail

MEDICARE: DR. JUAN JOSE BONILLA MD

MEDICARE: DR. JUAN JOSE BONILLA 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	1049084	IN
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036083958	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
2	526620	OTHER		COOK GROUP
3	202172	OTHER		URBANA/ROCKFORD/MOLINE
4	344390	OTHER		DUPAGE GROUP

General Provider Information

NPI Number	:	1558327015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN JOSE BONILLA MD

Provider Business Mailing Address
First Line	:	2650 WARRENVILLE RD
Second Line	:	STE 280
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1721
Country	:	US
Telephone Number	:	630-324-7900
Fax Number	:	630-271-1813

Provider Business Practice Location Address
First Line	:	1325 N HIGHLAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-1449
Country	:	US
Telephone Number	:	630-801-5700
Fax Number	:	630-801-5704

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/17/2021

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Directions to “ DR. JUAN JOSE BONILLA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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