Individual
DR. KEVIN BOUBOULEIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1969 W OGDEN AVE, CHICAGO, IL 60612-3765
(312) 864-6000
Mailing address
2108 N WINCHESTER AVE # 3, CHICAGO, IL 60614-3915
(847) 542-2688
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
125074524
IL
Other
Enumeration date
06/26/2019
Last updated
06/26/2019
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