Organization
21ST CENTURY UROLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT A. BONZANI MD (PRESIDENT)
(708) 364-7000
Entity
Organization
Contact information
Practice address
14315 108TH AVE, SUITE 230, ORLAND PARK, IL 60467-5700
(708) 364-7000
(708) 364-8000
Mailing address
14315 108TH AVE, SUITE 230, ORLAND PARK, IL 60467-5700
(708) 364-7000
(708) 364-8000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097795
—
IL
01
—
5642652
AETNA PROVIDER NUMBER
IL
Enumeration date
07/30/2006
Last updated
05/01/2008
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