Healthcare Provider Details

I. General information

NPI: 1871688572
Provider Name (Legal Business Name): WILLIAM F. PUGA, M.D. AND ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 W COLONIAL PKWY
INVERNESS IL
60067-1207
US

IV. Provider business mailing address

1644 W COLONIAL PKWY
INVERNESS IL
60067-1207
US

V. Phone/Fax

Practice location:
  • Phone: 847-776-4500
  • Fax: 847-776-4724
Mailing address:
  • Phone: 847-776-4500
  • Fax: 847-776-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM F PUGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-776-4500