# ROBERT A BONZANI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1376548750
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 03609775 | IL | — |
| 208800000X | Urology Physician | 01078104A | IN | — |
| 208800000X | Urology Physician | 12014 | ND | — |
| 208800000X | Urology Physician | 91544 | SC | Yes |

## Other

- **Enumeration date:** 06/14/2005
- **Last updated:** 05/06/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036097795 | — | IL |
| 05 | — | 16290 | — | ND |
| 01 | — | 5642652 | AETNA PROVIDER NUMBER | IL |
| 01 | — | 964290012 | PRNGRSMTH MEDICARE PTAN | IL |