Healthcare Provider Details

I. General information

NPI: 1134627789
Provider Name (Legal Business Name): MICHAEL JOHN BUEGE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S WOOD ST
CHICAGO IL
60612-7229
US

IV. Provider business mailing address

833 S WOOD ST
CHICAGO IL
60612-7229
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number051304715
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number064314
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number58522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: