DR. DIMITRIOS P BOUSOUNIS (NPI# 1861585408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861585408 |
| Entity Type | Individual |
| Full Name | DR. DIMITRIOS P BOUSOUNIS |
| Credential | M.D. |
| Practice Address |
200 W. Silver Spring Drive # 255 Glendale WI 53217 |
| Practice Telephone | 4149648450 |
| Practice Fax Number | 4149648451 |
| Mailing Telephone | 4149648450 |
| Mailing Fax Number | 4149648451 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-10-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 27172 | WI | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
27172 | WI | Allopathic & Osteopathic Physicians |
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
27172 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 30679100 | 05 |
| Street Address |
200 W. SILVER SPRING DRIVE # 255 |
| City | GLENDALE |
| State | WI |
| Zip Code | 53217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922632587 | Jasmine Dockery | Pharmacist | 5400 N Port Washington, Glendale, WI 53217 | 2020-02-23 |
| 1174017339 | North Lakes Nursing Home Health Care Agency LLC | Home Health | 225 E Fairmount Ave, Milwaukee, WI 53217 | 2018-06-20 |
| 1083140289 | Miriah Ann King, Ms, Lpc | Counselor | 7805 North Boyd Way, Fox Point, WI 53217 | 2017-05-08 |
| 1245783067 | Lakesha L Jones | Counselor | 5235 N Ironwood Rd, Glendale, WI 53217 | 2016-07-28 |
| 1750783312 | Ibrahim S Abouzeid | Specialist/Technologist, Other | 333 W Brown Deer Road, #240, Milwaukee, WI 53217 | 2014-09-25 |
| 1255733598 | Victoria Gorodetsky | Pharmacist | 229 W Indian Creek Ct, Milwaukee, WI 53217 | 2014-09-18 |
| 1174800049 | John Herman Esser | Internal Medicine | 1050 W Acacia Rd, Milwaukee, WI 53217 | 2011-11-07 |
| 1710298351 | Leann M Harman | Physical Therapist | 5333 N Port Washington Rd Ste B, Glendale, WI 53217 | 2010-06-29 |
| 1306012455 | Emily Marie Gallagher | Speech-Language Pathologist | 6700 N. Port Washington Road, Milwaukee, WI 53217 | 2008-05-07 |
| 1164625455 | Mary Catherine Enderlin | Psychologist | 6110 N Port Washington Road, The Cambridge Group, Glendale, WI 53217 | 2007-06-06 |
| Find all providers in zip 53217 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275957748 | Child Neurology of Beverly Hills | Psychiatry & Neurology | 501 W Glenoaks Blvd, # 705, Glendale, CA 91202-2896 | 2014-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376963694 | Shannon C Pollock | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2014-04-25 |
| 1972947224 | Samuel J Adams | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226 | 2013-04-17 |
| 1699036129 | Alexandria Lynn Lutley | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2012-05-31 |
| 1063779601 | Kumar R Sannagowdara | Psychiatry & Neurology | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2012-04-20 |
| 1942597356 | Lileth Joy Mondok | Psychiatry & Neurology | 9000 W Wisconsin Avenue, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2011-07-06 |
| 1144532052 | Raquel Farias-moeller | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2010-07-08 |
| 1801002092 | Delphin Sallowm | Psychiatry & Neurology | 9000 W Wisconsin Ave, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2007-05-15 |
| 1659443620 | Dorota Halina Telega | Psychiatry & Neurology | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2006-11-14 |
| 1063592301 | Sergio Facchini | Psychiatry & Neurology | 600 Highland Ave, Madison, WI 53792-0001 | 2006-10-17 |
| 1003912346 | Richard V Colan | Psychiatry & Neurology | 8825 S Howell Ave, Suite 101, Oak Creek, WI 53154-3760 | 2006-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.