Provider Demographics
NPI:1548224686
Name:BONZELET, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BONZELET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6810 STATE RT 162 BOX 215
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8501
Mailing Address - Country:US
Mailing Address - Phone:618-391-6405
Mailing Address - Fax:618-288-4088
Practice Address - Street 1:SEVEN 157 CENTER
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025
Practice Address - Country:US
Practice Address - Phone:618-659-2371
Practice Address - Fax:618-659-2375
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112688OtherBCBS MO
B51654OtherMERCY
68241OtherPRUCARE
IL036091754Medicaid
0409003OtherMEDICARE COMPLETE
112688OtherBLUECHOICE
277675OtherHEALTHLINK
0401769OtherUNITED HEALTHCARE
IL06022637OtherBCBS IL
112688OtherALLIANCE
33167OtherHEALTHPARTNERS GHP
33031OtherADVANTRA
33031OtherGHP
4652964OtherAETNA
371385704OtherCIGNA
6022637OtherBLUECARD