Provider Demographics
NPI:1851321467
Name:THOMAS, BONNIE WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:WILLIAM
Last Name:THOMAS
Suffix:JR
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 1:1525 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5512
Mailing Address - Country:US
Mailing Address - Phone:773-548-3957
Mailing Address - Fax:773-753-5590
Practice Address - Street 1:1525 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5512
Practice Address - Country:US
Practice Address - Phone:773-548-3957
Practice Address - Fax:773-753-5590
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101029207R00000X
IL036102029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102029Medicaid