Provider Demographics
NPI:1225100357
Name:JOHN BULGER, M. D., S. C.
Entity Type:Organization
Organization Name:JOHN BULGER, M. D., S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULGER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:630-325-9430
Mailing Address - Street 1:20 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3543
Mailing Address - Country:US
Mailing Address - Phone:630-325-9430
Mailing Address - Fax:630-325-9433
Practice Address - Street 1:20 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3543
Practice Address - Country:US
Practice Address - Phone:630-325-9430
Practice Address - Fax:630-325-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210922Medicare ID - Type Unspecified
I24797Medicare UPIN