Provider Demographics
NPI:1972600021
Name:ILAN D BORNSTEIN, M.D., L L C
Entity type:Organization
Organization Name:ILAN D BORNSTEIN, M.D., L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-356-9600
Mailing Address - Street 1:4750 WATERS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-356-9600
Mailing Address - Fax:912-356-5434
Practice Address - Street 1:4750 WATERS AVE STE 210
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6268
Practice Address - Country:US
Practice Address - Phone:912-356-9600
Practice Address - Fax:912-356-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCZPMedicare ID - Type UnspecifiedMEDICARE
GAF88246Medicare UPIN