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Organization
MICHAEL M BOUSTANY MD INC
Active
Organization
MICHAEL M BOUSTANY MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL M BOUSTANY MD (OWNER)
(304) 343-7557
Entity
Organization
Contact information
Practice address
415 MORRIS ST, STE 105, CHARLESTON, WV 25301-1840
(304) 343-7557
(304) 343-3441
Mailing address
PO BOX 3850, CHARLESTON, WV 25338-3850
(304) 233-9314
(304) 233-0265
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
10600
WV
2086S0129X
Vascular Surgery Physician
Primary
10600
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2065901
—
OH
05
—
6953086900
—
KY
Enumeration date
06/22/2005
Last updated
09/11/2025
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