Provider Demographics
NPI:1760646384
Name:GULLING, BRIDGET AGNES (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:AGNES
Last Name:GULLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4700
Mailing Address - Fax:630-933-4721
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4700
Practice Address - Fax:630-933-4721
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127363207R00000X, 208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127363Medicaid
IL206147OtherMEDICARE PTAN (GROUP)
ILP01013435OtherMEDICARE RAILROAD PTAN (INDIVIDUAL)
ILCA4748OtherMEDICARE RAILROAD PTAN (GROUP)
IL206147076OtherMEDICARE PTAN (GROUP)