Provider Demographics
NPI:1629342472
Name:BULBUL BAHUGUNA
Entity Type:Organization
Organization Name:BULBUL BAHUGUNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BULBUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHUGUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-907-2831
Mailing Address - Street 1:332 SKOKIE VALLEY RD
Mailing Address - Street 2:SUITE 225A
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4415
Mailing Address - Country:US
Mailing Address - Phone:773-907-2831
Mailing Address - Fax:773-751-2250
Practice Address - Street 1:332 SKOKIE VALLEY RD
Practice Address - Street 2:SUITE 225A
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4415
Practice Address - Country:US
Practice Address - Phone:773-907-2831
Practice Address - Fax:773-751-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360760012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215997Medicare Oscar/Certification