Organization
GREGORY BULAVA MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY M BULAVA M.D. (OWNER)
(847) 590-1500
Entity
Organization
Contact information
Practice address
5509 W MONTROSE AVE, CHICAGO, IL 60641-1331
(847) 590-1500
Mailing address
5509 W MONTROSE AVE, CHICAGO, IL 60641-1331
(847) 590-1500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036069715
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069715
—
IL
Enumeration date
12/01/2010
Last updated
12/01/2010
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