Individual
DR. DEREK SEAN BUMGARNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2160 S 1ST AVE, DEPARTMENT OF PATHOLOGY BUILDING 110 ROOM 2209, MAYWOOD, IL 60153-3328
(708) 216-3250
(708) 327-2620
Mailing address
2160 S 1ST AVE, DEPARTMENT OF PATHOLOGY BUILDING 110 ROOM 2209, MAYWOOD, IL 60153-3328
(708) 216-3250
(708) 327-2620
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036.138853
IL
Other
Enumeration date
03/19/2013
Last updated
08/07/2015
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