Provider Demographics
NPI:1205038015
Name:BORMES UROLOGY, S.C.
Entity Type:Organization
Organization Name:BORMES UROLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BORMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-625-6590
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-625-6590
Mailing Address - Fax:847-625-6592
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 128
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-625-6590
Practice Address - Fax:847-625-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1637650OtherBCBS
IL36072689Medicaid
K38649Medicare UPIN
1637650OtherBCBS