Provider Demographics
NPI:1326123480
Name:BOURY, HARB NICOLAS (MD)
Entity Type:Individual
Prefix:
First Name:HARB
Middle Name:NICOLAS
Last Name:BOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E GUNDERSEN DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2453
Mailing Address - Country:US
Mailing Address - Phone:630-653-2599
Mailing Address - Fax:630-653-7843
Practice Address - Street 1:327 E GUNDERSEN DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2453
Practice Address - Country:US
Practice Address - Phone:630-653-2599
Practice Address - Fax:630-653-7843
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045527207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
679440Medicare ID - Type Unspecified
D14777Medicare UPIN