Provider Demographics
NPI:1912981366
Name:BAHUGUNA, BULBUL (MD)
Entity type:Individual
Prefix:DR
First Name:BULBUL
Middle Name:
Last Name:BAHUGUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 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:847-675-7737
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:847-675-7737
Practice Address - Fax:773-751-2250
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360760012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076001Medicaid
C51087Medicare UPIN
IL036076001Medicaid