Bonzani, Robert A
Bonzani, Robert A is an sole proprietor health care provider with primary practice located at 1615 Winsted Dr Ste 4, Goshen IN 46526-4696. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Bonzani, Robert A can be contacted via phone (574) 364-2875.Contact Information
Primary practice address
1615 Winsted Dr Ste 4
Goshen IN 46526-4696
Phone: (574) 364-2875
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 03609775 | Illinois |
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 12014 | North Dakota |
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 01078104A | Indiana |
Profile Details
| NPI number | 1376548750 |
|---|---|
| LBN Legal business name | Bonzani, Robert A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 14th, 2005 |
| Last updated | Feb 15th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376548750 | NPPES |
| Illinois | Other | 5642652 | AETNA PROVIDER NUMBER |
| Illinois | MEDICAID | 036097795 | AETNA PROVIDER NUMBER |
| Illinois | MEDICAID | 16290 | AETNA PROVIDER NUMBER |
| Illinois | Other | 964290012 | AETNA PROVIDER NUMBER |
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