Basic Information
| Provider Information | |||||||||
| NPI: | 1548899545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONZHEIM | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9650 GROSS POINT RD STE 3900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600765085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701700 | ||||||||
| FaxNumber: | 2242514569 | ||||||||
| Practice Location | |||||||||
| Address1: | 9650 GROSS POINT RD STE 3900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600765085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701700 | ||||||||
| FaxNumber: | 2242514569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2020 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601009987 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.