Provider Demographics
NPI:1700814126
Name:BONADONNA, ANNA M (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:BONADONNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 3900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-677-1400
Mailing Address - Fax:847-933-3531
Practice Address - Street 1:9650 GROSS POINT RD STE 3900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-677-1400
Practice Address - Fax:847-933-3531
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036095411207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633977OtherBLUECROSS
208510Medicare ID - Type Unspecified
G84895Medicare UPIN