Provider Demographics
NPI:1427001486
Name:BONAMINIO, ROBERT M (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:BONAMINIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W. 95TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-636-9205
Mailing Address - Fax:708-229-6075
Practice Address - Street 1:2850 W. 95TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-636-9205
Practice Address - Fax:708-229-6075
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094083207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094083Medicaid
ILH19726Medicare UPIN
IL036094083Medicaid