Individual
MICHAEL BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8333 NAAB RD STE 250, INDIANAPOLIS, IN 46260-1983
(317) 338-5100
Mailing address
8333 NAAB RD STE 250, INDIANAPOLIS, IN 46260-1983
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01054000A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200420800A
—
IN
01
—
P01214629
RR MEDICARE PTAN
IN
Enumeration date
06/13/2005
Last updated
10/17/2024
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