Provider Demographics
NPI:1285851246
Name:BONHOMME, CHRISTINE O'CONNOR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:O'CONNOR
Last Name:BONHOMME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WILLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1643
Mailing Address - Country:US
Mailing Address - Phone:708-839-1862
Mailing Address - Fax:
Practice Address - Street 1:5101 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2600
Practice Address - Country:US
Practice Address - Phone:708-245-8975
Practice Address - Fax:708-245-5615
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49212020207Q00000X
FLME85965207Q00000X
IN01054779A207Q00000X
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH95903Medicare UPIN
FL29135XMedicare ID - Type Unspecified