Provider Demographics
NPI:1710120779
Name:BUSH, JOHN G JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:BUSH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2801 LAKESIDE DR
Mailing Address - Street 2:STE 209
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1271
Mailing Address - Country:US
Mailing Address - Phone:847-562-1410
Mailing Address - Fax:847-562-0830
Practice Address - Street 1:350 S NORTHWEST HWY STE 112
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4262
Practice Address - Country:US
Practice Address - Phone:847-825-8108
Practice Address - Fax:847-825-1774
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.133513207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01242540OtherTRICARE
ILF400096881Medicare PIN