Individual
RIDA W BOULOS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
DEPT OF OB / GYN, 530 NE GLEN OAK, PEORIA, IL 61637-0001
(309) 655-3024
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215036
BCBS
IL
Enumeration date
02/14/2006
Last updated
07/09/2007
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