Individual
AMANI BOULOS MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2 PHEASANT RIDGE RD, CANTON, MA 02021-2650
(781) 363-5801
(781) 828-1106
Mailing address
2 PHEASANT RIDGE RD, CANTON, MA 02021-2650
(781) 363-5801
(781) 828-1106
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
161106
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2023377
—
MA
Enumeration date
10/20/2005
Last updated
04/08/2013
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