Provider Demographics
NPI:1558327015
Name:BONILLA, JUAN JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOSE
Last Name:BONILLA
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 1:2650 WARRENVILLE RD
Mailing Address - Street 2:STE 280
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1721
Mailing Address - Country:US
Mailing Address - Phone:630-324-7900
Mailing Address - Fax:630-271-1813
Practice Address - Street 1:1325 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1449
Practice Address - Country:US
Practice Address - Phone:630-801-5700
Practice Address - Fax:630-801-5704
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1049084208G00000X
IL036083958208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36083958Medicaid
526620OtherCOOK GROUP
202172OtherURBANA/ROCKFORD/MOLINE
344390OtherDUPAGE GROUP
ILL61746Medicare ID - Type Unspecified
G52618Medicare UPIN
ILL92747Medicare ID - Type Unspecified
ILL67318Medicare ID - Type Unspecified
526620OtherCOOK GROUP