MEDICARE: DR. BULBUL BAHUGUNA MD

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
1	2084P0800X	Psychiatry Physician	036076001	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1912981366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BULBUL BAHUGUNA MD

Provider Business Mailing Address
First Line	:	332 SKOKIE VALLEY RD
Second Line	:	SUITE 225A
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4415
Country	:	US
Telephone Number	:	847-675-7737
Fax Number	:	773-751-2250

Provider Business Practice Location Address
First Line	:	332 SKOKIE VALLEY RD
Second Line	:	SUITE 225A
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4415
Country	:	US
Telephone Number	:	847-675-7737
Fax Number	:	773-751-2250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/26/2010

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