Provider Demographics
NPI:1760432470
Name:BONHOMME, CHAD E (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:BONHOMME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:317-621-8500
Practice Address - Fax:317-621-8501
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053007A207RC0000X, 207RC0001X
WI48008020207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616378OtherBCBS
IL1316998578OtherGROUP PRACTICE NPI
ILK31800OtherMEDICARE PIN-LOCALITY 15
IL7478874OtherAETNA
ILP00352819OtherRRMC-LOCALITY 16
INP01191751OtherRR MEDICARE PTAN
ILK31805OtherMEDICARE PIN-LOCALITY 16
ILP00392473OtherRRMC-LOCALITY 15
ILK31800OtherMEDICARE PIN-LOCALITY 15
IN251320RRRMedicare PIN
IN266180108Medicare PIN