Healthcare Provider Details

I. General information

NPI: 1437384047
Provider Name (Legal Business Name): YEVGENY BULBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N MILWAUKEE AVE STE 103
NILES IL
60714-3124
US

IV. Provider business mailing address

7800 N MILWAUKEE AVE STE 103
NILES IL
60714-3124
US

V. Phone/Fax

Practice location:
  • Phone: 224-888-3033
  • Fax:
Mailing address:
  • Phone: 224-888-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.136818
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35099388
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036136818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: