Healthcare Provider Details

I. General information

NPI: 1235163437
Provider Name (Legal Business Name): TERRENCE J BUGNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 W MEDICAL CENTER DR
MCHENRY IL
60050-8425
US

IV. Provider business mailing address

PO BOX 734138
CHICAGO IL
60673-4138
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-8000
  • Fax: 815-759-4075
Mailing address:
  • Phone: 815-344-8000
  • Fax: 815-759-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036066962
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: