Individual
DR. DIMITRIOS P BOUSOUNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W. SILVER SPRING DRIVE, # 255, GLENDALE, WI 53217
(414) 964-8450
(414) 964-8451
Mailing address
200 W. SILVER SPRING DRIVE, # 255, GLENDALE, WI 53217
(414) 964-8450
(414) 964-8451
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
27172
WI
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
27172
WI
2084N0600X
Clinical Neurophysiology Physician
27172
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30679100
—
WI
Enumeration date
10/02/2006
Last updated
10/17/2007
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