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NPI Code Detail

MEDICARE: PHYLLIS N BONAMINIO MD

MEDICARE: PHYLLIS N BONAMINIO 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
1207RR0500XRheumatology Physician036104900IL

General Provider Information

NPI Number : 1841289527
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS N BONAMINIO MD
Provider Business Mailing Address
First Line : 7600 W COLLEGE DR
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1001
Country : US
Telephone Number : 708-361-0600
Fax Number : 708-923-2329
Provider Business Practice Location Address
First Line : 5540 W 111TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-5574
Country : US
Telephone Number : 708-423-8440
Fax Number : 708-658-2962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 12/31/2018

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Directions to “ PHYLLIS N BONAMINIO MD” Practice Location

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