Provider Demographics
NPI:1538521505
Name:BOURGEOIS, ISAAC J (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:J
Last Name:BOURGEOIS
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 1:710 N LAKE SHORE DR
Mailing Address - Street 2:ABBOTT HALL, #1115
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3006
Mailing Address - Country:US
Mailing Address - Phone:312-503-1398
Mailing Address - Fax:
Practice Address - Street 1:710 N LAKE SHORE DR
Practice Address - Street 2:ABBOTT HALL, #1115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3006
Practice Address - Country:US
Practice Address - Phone:312-503-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1528642084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care