Provider Demographics
NPI:1215944947
Name:BONFIGLIO, RONALD LEE (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5900
Mailing Address - Country:US
Mailing Address - Phone:419-996-5224
Mailing Address - Fax:931-962-8588
Practice Address - Street 1:770 W HIGH ST STE 160
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-996-5224
Practice Address - Fax:419-996-5276
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1768208100000X
OH35061226208100000X
TN53781208100000X
KY57000208100000X
IN01057501A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201080010Medicaid
AZZ119997Medicare PIN
IN260690002Medicare PIN