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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 9 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.

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Identifiers

StateTypeNumberIssuer
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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