Individual
DR. PETER A BOULUKOS
Active
Individual
DR. PETER A BOULUKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
141481-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00535199
—
NY
01
—
141481-2 CAN
WORKERS COMPENSATION
NY
01
—
PB027A5210
BLUE CROSS BLUE SHILED
NY
Enumeration date
12/04/2006
Last updated
12/13/2023
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