Provider Demographics
NPI:1649224288
Name:BONET, JERRY P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:P
Last Name:BONET
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6136
Mailing Address - Country:US
Mailing Address - Phone:708-352-5652
Mailing Address - Fax:708-352-2105
Practice Address - Street 1:1415 W 47TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6136
Practice Address - Country:US
Practice Address - Phone:708-352-5652
Practice Address - Fax:708-352-2105
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-00316-0213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP15961Medicare ID - Type Unspecified
ILT38051Medicare UPIN