Provider Demographics
NPI:1093751257
Name:BONELLO, JULIUS P (MD)
Entity Type:Individual
Prefix:MR
First Name:JULIUS
Middle Name:P
Last Name:BONELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606
Mailing Address - Country:US
Mailing Address - Phone:309-495-0200
Mailing Address - Fax:309-676-6545
Practice Address - Street 1:1001 MAIN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606
Practice Address - Country:US
Practice Address - Phone:309-495-0200
Practice Address - Fax:309-676-6545
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058876-1208600000X
IL036058876208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215166OtherBCBS
IL036058876-1Medicaid
IL7215166OtherBCBS