Provider Demographics
NPI:1114931870
Name:ALEXANDER, BONITA S (MD)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:S
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:S
Other - Last Name:ALEXANDER PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:355 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3167
Mailing Address - Country:US
Mailing Address - Phone:312-238-1000
Mailing Address - Fax:
Practice Address - Street 1:955 BEISNER RD STE 1509
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3475
Practice Address - Country:US
Practice Address - Phone:847-631-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-072596208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072596Medicaid
IL250012489OtherRAILROAD MEDICARE
IL250012490OtherRR MEDICARE
D16527Medicare UPIN
IL250012490OtherRR MEDICARE