Basic Information
| Provider Information | |||||||||
| NPI: | 1629342472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BULBUL BAHUGUNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 SKOKIE VALLEY RD | ||||||||
| Address2: | SUITE 225A | ||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600354415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739072831 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 SKOKIE VALLEY RD | ||||||||
| Address2: | SUITE 225A | ||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600354415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739072831 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2012 | ||||||||
| LastUpdateDate: | 02/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | BAHUGUNA | ||||||||
| AuthorizedOfficialFirstName: | BULBUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRES | ||||||||
| AuthorizedOfficialTelephone: | 7739072831 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 036076001 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.