Provider Demographics
NPI:1104976117
Name:BONE HEALTH MANAGEMENT
Entity type:Organization
Organization Name:BONE HEALTH MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DIMUZIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-945-6552
Mailing Address - Street 1:720 OSTERMAN AVE
Mailing Address - Street 2:#102
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4471
Mailing Address - Country:US
Mailing Address - Phone:847-945-6552
Mailing Address - Fax:847-945-6564
Practice Address - Street 1:720 OSTERMAN AVE
Practice Address - Street 2:#102
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4471
Practice Address - Country:US
Practice Address - Phone:847-945-6552
Practice Address - Fax:847-945-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL596800Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER