Provider Demographics
NPI:1922016765
Name:BUKOWY, RONALD B (MD SC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:BUKOWY
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 KESLINGER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4645
Mailing Address - Country:US
Mailing Address - Phone:630-262-1500
Mailing Address - Fax:630-262-1518
Practice Address - Street 1:2700 KESLINGER RD
Practice Address - Street 2:SUITE B
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4645
Practice Address - Country:US
Practice Address - Phone:630-262-1500
Practice Address - Fax:630-262-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360523662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-3996904OtherHFN
IL0004500696OtherBCBS
IL036052366Medicaid
IL130015613Medicare PIN
IL0004500696OtherBCBS
IL036052366Medicaid