Provider Demographics
NPI:1285687996
Name:BONUTTI ORTHOPEDIC SERVICES LTD
Entity type:Organization
Organization Name:BONUTTI ORTHOPEDIC SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO & VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-258-2102
Mailing Address - Street 1:1303 W EVERGREEN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1619
Mailing Address - Country:US
Mailing Address - Phone:217-342-3400
Mailing Address - Fax:217-342-6416
Practice Address - Street 1:1303 W EVERGREEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-342-3400
Practice Address - Fax:217-342-6416
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRACTICE ACQUISITION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060005120207X00000X, 207XS0106X, 2083S0010X, 2083X0100X
IL207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL166708OtherHEALTHLINK
IL2500074OtherBLUECROSS BLUE SHIELD
IL2500074OtherBLUECROSS BLUE SHIELD
IL2500074OtherBLUECROSS BLUE SHIELD
IL166708OtherHEALTHLINK