Provider Demographics
NPI:1831140797
Name:DULCE, HUGO E (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:E
Last Name:DULCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 E LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101
Mailing Address - Country:US
Mailing Address - Phone:630-833-5838
Mailing Address - Fax:630-833-3266
Practice Address - Street 1:580 E LAKE STREET
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101
Practice Address - Country:US
Practice Address - Phone:630-833-5838
Practice Address - Fax:630-833-3266
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101192Medicaid
IL203655OtherPTAN NUMBER
IL036101192Medicaid
H53954Medicare UPIN