Basic Information
| Provider Information | |||||||||
| NPI: | 1487726782 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WILLIAM G BONZELET MD, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 157 CTR | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186592371 | ||||||||
| FaxNumber: | 6186592375 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 157 CTR | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186592371 | ||||||||
| FaxNumber: | 6186592375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | BONZELET | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6186592371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036091754 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.