Provider Demographics
NPI:1316180102
Name:TSE, BONNIE (MD)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:TSE
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 1:1355 REMINGTON RD
Mailing Address - Street 2:STE H
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4818
Mailing Address - Country:US
Mailing Address - Phone:708-429-7039
Mailing Address - Fax:708-429-7039
Practice Address - Street 1:4177 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-1849
Practice Address - Country:US
Practice Address - Phone:773-254-2222
Practice Address - Fax:773-254-8444
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130238207Q00000X, 207RG0300X, 207R00000X
IL125.056301207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program