Healthcare Provider Details

I. General information

NPI: 1972880409
Provider Name (Legal Business Name): CORNELIA JOSEPHINE BUGG AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E ONTARIO ST SUITE 1100
CHICAGO IL
60611-2874
US

IV. Provider business mailing address

142 E ONTARIO ST SUITE 1100
CHICAGO IL
60611-2874
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-7171
  • Fax:
Mailing address:
  • Phone: 312-263-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001416
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: