Provider Demographics
NPI:1053601583
Name:BOUNDAOUI, OUSSAMA (MD)
Entity type:Individual
Prefix:
First Name:OUSSAMA
Middle Name:
Last Name:BOUNDAOUI
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 1:1211 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3142
Mailing Address - Country:US
Mailing Address - Phone:847-264-2222
Mailing Address - Fax:847-437-6841
Practice Address - Street 1:1211 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3142
Practice Address - Country:US
Practice Address - Phone:847-264-2222
Practice Address - Fax:847-437-6841
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-140758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL915420Medicare UPIN