Active NPI
Bonaventure Suiru Dzekem, MD, MA
- Cardiovascular Disease Physician
- Boston, MA
National Provider Identifier
1003551433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 1023634
- Practice address
- 75 Francis St
Boston, MA 02115-6110 - Phone
- (857) 307-4000
- NPI assigned
- Apr 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125.079841 | IL | |
| Internal Medicine Physician | 207R00000X | 1023634 | MA | |
| Cardiovascular Disease Physician | 207RC0000X | 1023634 | MA | Primary |
Addresses
Primary practice location
75 Francis St
Boston, MA 02115-6110
Mailing address
75 Francis St
Boston, MA 02115-6110
Phone (857) 307-4000
Other practice location 1
5841 S Maryland Ave Ste Mc7082
Chicago, IL 60637-1465
Phone (773) 702-6840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.079841 | IL | MD | Internal Medicine Physician |
| 1023634 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742774400000",
"number": "1003551433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 FRANCIS ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021156110",
"telephone_number": "857-307-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 FRANCIS ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021156110",
"telephone_number": "857-307-4000"
}
],
"practiceLocations": [
{
"address_1": "5841 S Maryland Ave Ste Mc7082",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606371465",
"country_code": "US",
"telephone_number": "773-702-6840",
"fax_number": "773-834-3950",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DZEKEM",
"first_name": "BONAVENTURE",
"middle_name": "SUIRU",
"name_prefix": "Dr.",
"credential": "MD, MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-29",
"last_updated": "2025-03-24",
"certification_date": "2025-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125.079841",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "1023634",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MA",
"license": "1023634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.