Provider Demographics
NPI:1851309041
Name:BONAGURO, RONALD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:BONAGURO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5660 W 95TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2300
Mailing Address - Country:US
Mailing Address - Phone:708-425-0112
Mailing Address - Fax:708-425-2785
Practice Address - Street 1:5660 W 95TH ST STE 4
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-425-0112
Practice Address - Fax:708-425-2785
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068125208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
214706016Medicare PIN
K20451Medicare PIN
ILC48959Medicare UPIN