Basic Information
| Provider Information | |||||||||
| NPI: | 1548224686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONZELET | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6810 STATE RT 162 BOX 215 | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620628501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183916405 | ||||||||
| FaxNumber: | 6182884088 | ||||||||
| Practice Location | |||||||||
| Address1: | SEVEN 157 CENTER | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186592371 | ||||||||
| FaxNumber: | 6186592375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036091754 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 112688 | 01 | MO | BCBS MO | OTHER | B51654 | 01 | MERCY | OTHER | 68241 | 01 | PRUCARE | OTHER | 036091754 | 05 | IL | MEDICAID | 0409003 | 01 | MEDICARE COMPLETE | OTHER | 112688 | 01 | BLUECHOICE | OTHER | 277675 | 01 | HEALTHLINK | OTHER | 0401769 | 01 | UNITED HEALTHCARE | OTHER | 06022637 | 01 | IL | BCBS IL | OTHER | 112688 | 01 | ALLIANCE | OTHER | 33167 | 01 | HEALTHPARTNERS GHP | OTHER | 33031 | 01 | ADVANTRA | OTHER | 33031 | 01 | GHP | OTHER | 4652964 | 01 | AETNA | OTHER | 371385704 | 01 | CIGNA | OTHER | 6022637 | 01 | BLUECARD | OTHER |