Individual
NIHAD M BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 TUSCARAWAS ST W, STE 100, CANTON, OH 44708-4696
(330) 452-8844
(330) 452-7012
Mailing address
2600 TUSCARAWAS ST W, STE 100, CANTON, OH 44708-4696
(330) 452-8844
(330) 452-7012
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
35-065732
OH
207RP1001X
Pulmonary Disease Physician
35-065732
OH
207RS0012X
Sleep Medicine (Internal Medicine) Physician
35-065732
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000186380
UNISON HEALTH PLAN
OH
01
—
000000283988
ANTHEM BC/BS
OH
05
—
2401672
—
OH
01
—
341574729036
CARESOURCE
OH
01
—
341574729F
AULTCARE
OH
01
—
733560
BUCKEYE COMMUNITY HEALTH
OH
01
—
Q035419
THE HEALTH PLAN
OH
Enumeration date
05/24/2005
Last updated
01/05/2011
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