Provider Demographics
NPI:1316122898
Name:DUGO, JAMES M (PH D)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:DUGO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:84 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2348
Mailing Address - Country:US
Mailing Address - Phone:847-635-2040
Mailing Address - Fax:847-635-9277
Practice Address - Street 1:84 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2348
Practice Address - Country:US
Practice Address - Phone:847-635-2040
Practice Address - Fax:847-635-9277
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-00175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208251Medicare PIN