Healthcare Provider Details

I. General information

NPI: 1497628028
Provider Name (Legal Business Name): STEVEN JOSEPH BUKAUSKAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 KEDZIE AVE
HAZEL CREST IL
60429-2029
US

IV. Provider business mailing address

1617 AMHURST WAY
BOURBONNAIS IL
60914-6600
US

V. Phone/Fax

Practice location:
  • Phone: 815-531-9292
  • Fax:
Mailing address:
  • Phone: 815-531-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.033050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: