# DIMITRIOS P BOUSOUNIS MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073666269
- **Authorized official:** DR. DIMITRIOS P BOUSOUNIS MD (OWNER)
- **Authorized official phone:** (414) 964-8450

## Contact information

- **Practice address:** 200 W SILVER SPRING DR STE 255, GLENDALE, WI 53217-5058
- **Practice address phone:** (414) 964-8450
- **Practice address fax:** (414) 964-8451
- **Mailing address:** 200 W SILVER SPRING DR STE 255, GLENDALE, WI 53217-5058
- **Mailing address phone:** (414) 964-8450
- **Mailing address fax:** (414) 964-8451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 27172 | WI | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 04/24/2008