Michael Boulos
Critical Care Medicine
7250 Clearvista Dr Ste 120
Indianapolis
, Indiana 46256-4640
Michael Boulos
Critical Care Medicine
7250 Clearvista Dr Ste 120
Indianapolis
, Indiana 46256-4640
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About
Features
Specialties
- Critical Care Medicine
Languages spoken
- English
Location
First Address
- Michael Boulos
- 6626 E 75th St Suite 500
- Indianapolis, IN
- Zip : 46250-2805
- Phone :
Second Address
- Michael Boulos
- 7250 Clearvista Dr Ste 120
- Indianapolis, IN
- Zip : 46256-4640
- Fax : (317) 621-5678
- Phone : (317) 621-5676
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RC0200X | Critical Care Medicine | 01054000A | IN |
National Provider Identifier
| NPI | 1083618581 |
|---|---|
| Provider Name | Michael Boulos |
| First Address | Indianapolis, IN 46250-2805 |
| Second Address | Indianapolis, IN 46256-4640 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/06/2005 |
| Last Update Date | 25/11/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 200420800A | (05) | IN |
| H35323 | (02) | IN |
| P01214629 | RR MEDICARE PTAN (01) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.