Individual
VINCENT M BOURNIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8075 N SHADELAND AVE, #350, INDIANAPOLIS, IN 46250-2693
(317) 678-3900
(317) 841-0395
Mailing address
1600 S 20TH AVE, #350, SAFFORD, AZ 85546-4011
(928) 348-4037
(855) 876-8606
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01029804A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10385690
—
IN
Enumeration date
04/27/2006
Last updated
01/18/2017
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