Provider Demographics
NPI:1386725125
Name:BONYO, BENSON S (DO)
Entity type:Individual
Prefix:
First Name:BENSON
Middle Name:S
Last Name:BONYO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 TRELLIS GREEN DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1668
Mailing Address - Country:US
Mailing Address - Phone:330-665-4745
Mailing Address - Fax:330-665-4740
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007305B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134221Medicaid
OHH65850Medicare UPIN
OH2134221Medicaid