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NPI Code Detail

MEDICARE: GREGORY BULAVA MD LTD

MEDICARE: GREGORY BULAVA MD LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036069715IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477855146
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREGORY BULAVA MD LTD
Provider Business Mailing Address
First Line : 5509 W MONTROSE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-1331
Country : US
Telephone Number : 847-590-1500
Fax Number :
Provider Business Practice Location Address
First Line : 5509 W MONTROSE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-1331
Country : US
Telephone Number : 847-590-1500
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GREGORY M BULAVA
Credential : M.D.
Telephone Number : 847-590-1500
Provider Enumeration Date : 12/01/2010
Last Update Date : 12/01/2010

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