MEDICARE: MR. BRETT MATTHEW BONHAM

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	237700000X	Hearing Instrument Specialist	AS4103	FL

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	:	1558796540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRETT MATTHEW BONHAM

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD STE 401
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8123
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	2701 CLEVELAND AVE STE 140
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5800
Country	:	US
Telephone Number	:	239-461-9321
Fax Number	:	239-461-5354

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

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	06/04/2020

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Directions to “ MR. BRETT MATTHEW BONHAM ” Practice Location

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