Provider Demographics
NPI:1154543213
Name:B S BONYO DO & ASSOCIATES INC
Entity type:Organization
Organization Name:B S BONYO DO & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONYO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-867-7544
Mailing Address - Street 1:1569 VERNON ODOM BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4089
Mailing Address - Country:US
Mailing Address - Phone:330-867-7544
Mailing Address - Fax:330-867-7434
Practice Address - Street 1:1569 VERNON ODOM BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4089
Practice Address - Country:US
Practice Address - Phone:330-867-7544
Practice Address - Fax:330-867-7434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007305B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2735562Medicaid
OH2314221Medicaid
OHH65850Medicare UPIN