Active NPI
Athanasios Bonoris, MD
- Specialist
- Des Plaines, IL
National Provider Identifier
1962453027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 036-077564
- Practice address
- 1726 S Elm St
Des Plaines, IL 60018-2216 - Phone
- (847) 824-4873
- NPI assigned
- May 13, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 036-077564 | IL | Primary |
Addresses
Primary practice location
1726 S Elm St
Des Plaines, IL 60018-2216
Mailing address
1726 S Elm St
Des Plaines, IL 60018-2216
Phone (847) 824-4873
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036077564 | Medicaid | IL | |
| 01607270 | Other | BLUE SHIELD | |
| 110132651 | Other | PALMETTO GBA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-077564 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1962453027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1726 S ELM ST",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600182216",
"telephone_number": "847-824-4873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1726 S ELM ST",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600182216",
"telephone_number": "847-824-4873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONORIS",
"first_name": "ATHANASIOS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "036-077564",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036077564",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "01607270",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "110132651",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Des Plaines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.