Provider Demographics
NPI:1477522050
Name:BUKA, JONATHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:BUKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4400 W 95TH ST STE 312
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2660
Mailing Address - Country:US
Mailing Address - Phone:708-581-3514
Mailing Address - Fax:708-952-0329
Practice Address - Street 1:4400 W 95TH ST STE 312
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2660
Practice Address - Country:US
Practice Address - Phone:708-581-3514
Practice Address - Fax:708-529-3123
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053839A207W00000X
IL036066839207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200325390OtherMEDICARE LEGACY PROVIDER NUMBER
IN200871680AOtherMEDICAID LOCATION MUNSTER
IL180046208OtherMEDICARE RAILROAD
IN200325390BOtherIN PHYSICIANS MEDICAID
IL833002861Medicaid
ILL77581OtherMEDICARE INDIVIDUAL PTAN
IL205785OtherPTAN IL MEDICARE COOK COUNTY
ILP00932946OtherMEDICARE RAILROAD DUPAGE CO. INDIVIDUAL PTAN
IL036066839Medicaid
IN200871680BOtherMEDICAID LOCATION CHICAGO RIDGE
IN200871680COtherMEDICAID LOCATION ORLAND PARK
IL205786OtherPTAN IL MEDICARE DUPAGE COUNTY
ILDR4230OtherMEDICARE RAILROAD GROUP PTAN DUPAGE CO.
IN200871680DOtherMEDICAID LOCATION HINSDALE
IN253350OtherPTAN GROUP PRACTICE INDIANA MEDICARE
IL6180260001Medicare NSC
IL205786OtherPTAN IL MEDICARE DUPAGE COUNTY