Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35.094280 | OH |
N | 207RI0011X | Interventional Cardiology | 35094280 | OH |
NPI | 1003976507 |
---|---|
Provider Name | Dr. Konstantinos D Boudoulas |
First Address | Columbus, OH 43202-1559 |
Second Address | Dublin, OH 43017-2289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2997119 | (05) | OH |