Basic Information
| Provider Information | |||||||||
| NPI: | 1841289527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONAMINIO | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 W COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083610600 | ||||||||
| FaxNumber: | 7089232329 | ||||||||
| Practice Location | |||||||||
| Address1: | 5540 W 111TH ST | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604535574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084238440 | ||||||||
| FaxNumber: | 7086582962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 036104900 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.