Provider Demographics
NPI:1235163437
Name:BUGNO, TERRENCE J (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:J
Last Name:BUGNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734138
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4138
Mailing Address - Country:US
Mailing Address - Phone:815-344-8000
Mailing Address - Fax:815-759-4075
Practice Address - Street 1:4305 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8425
Practice Address - Country:US
Practice Address - Phone:815-344-8000
Practice Address - Fax:815-759-4075
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360669622085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066962-1Medicaid
L84197Medicare ID - Type Unspecified
IL036066962-1Medicaid