Provider Demographics
NPI:1447575642
Name:BOURNAS, VASILIOS G (DO)
Entity Type:Individual
Prefix:
First Name:VASILIOS
Middle Name:G
Last Name:BOURNAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:G
Other - Last Name:BOURNAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6632 N KOLMAR AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3332
Mailing Address - Country:US
Mailing Address - Phone:630-532-2841
Mailing Address - Fax:
Practice Address - Street 1:1032 E SUMNER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1608
Practice Address - Country:US
Practice Address - Phone:262-673-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60856207P00000X
IL036.132065207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100030222Medicaid