Provider Demographics
NPI:1134161268
Name:BOUR, JAMES B (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:BOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M206C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-488-8305
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M206C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-488-8305
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301405948208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4348838OtherAETNA PIN
MI3107744-10Medicaid
MI3403900691OtherBCBS IND PIN
112345OtherGREAT LAKES HLTH PLN
MI340C910480OtherBCBS GRP PIN
MI3403900691OtherBCBS IND PIN
383148262OtherEIN-HEALTHCARE MIDWEST
MI340011241Medicare PIN
MICC4780Medicare PIN
MI3107744-10Medicaid