Individual
JACK GLENN HUGULEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
811 SOUTH STATE STREET, SUITEB, CHICAGO, IL 60605-0000
(312) 566-9510
(312) 566-9511
Mailing address
PO BOX 544, DEPT 5390, MILWAUKEE, WI 53201-0544
(815) 713-2600
(815) 654-5020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003674
IL
364SE0003X
Emergency Clinical Nurse Specialist
PA16498
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003674
IL PA LICENSE
IL
Enumeration date
02/17/2006
Last updated
02/10/2010
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