Individual
EMAN BOULIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
210 4TH AVE, GRINNELL, IA 50112-1898
(641) 236-7511
(641) 236-2058
Mailing address
210 4TH AVE, GRINNELL, IA 50112-1898
(641) 236-7511
(641) 236-2058
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD433023
PA
207RR0500X
Rheumatology Physician
Primary
20150
MS
207RR0500X
Rheumatology Physician
MD-41825
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102065830
—
PA
01
—
1246481
IA CSA
IA
01
—
MD-41825
IA LICENSE
IA
Enumeration date
12/31/2007
Last updated
03/07/2023
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