Provider Demographics
NPI:1871564013
Name:BOUINYI, LEONID (MD)
Entity type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:BOUINYI
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 1:709 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7614
Mailing Address - Country:US
Mailing Address - Phone:262-767-6020
Mailing Address - Fax:262-767-6023
Practice Address - Street 1:709 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-7614
Practice Address - Country:US
Practice Address - Phone:262-767-6020
Practice Address - Fax:262-767-6023
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI468040202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871564013Medicaid
WI1871564013Medicaid
WII04637Medicare UPIN
IL209652Medicare PIN