Provider Demographics
NPI:1083773535
Name:NUGENT, COLLEEN MALLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MALLEY
Last Name:NUGENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ELAINE
Other - Last Name:MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 COMPASS RD
Mailing Address - Street 2:SUITE C-D
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1610
Mailing Address - Country:US
Mailing Address - Phone:847-998-0010
Mailing Address - Fax:847-998-1171
Practice Address - Street 1:2550 COMPASS RD
Practice Address - Street 2:SUITE C-D
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1610
Practice Address - Country:US
Practice Address - Phone:847-998-0010
Practice Address - Fax:847-998-1171
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH07662Medicare UPIN
ILIL1254002Medicare PIN