Individual
THOMAS BOENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 W. PARK ST.. #2, URBANA, IL 61801-1790
(360) 201-2007
Mailing address
401 W PARK ST APT 2, URBANA, IL 61801-1790
(360) 201-2007
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101245602
VA
246ZC0007X
Surgical Assistant
Primary
238.000284
IL
Other
Enumeration date
05/07/2008
Last updated
08/29/2011
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