Provider Demographics
NPI:1518485960
Name:BOBBY BUONAURO CLINIC
Entity Type:Organization
Organization Name:BOBBY BUONAURO CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONAURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-869-1808
Mailing Address - Street 1:1029 HOWARD ST STE 303
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3877
Mailing Address - Country:US
Mailing Address - Phone:847-869-1808
Mailing Address - Fax:847-869-1950
Practice Address - Street 1:1029 HOWARD ST STE 303
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3877
Practice Address - Country:US
Practice Address - Phone:847-869-1808
Practice Address - Fax:847-869-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
ILA-8746-0001-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone