Individual
MICHAEL M BOUSTANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
434 DIVISION ST, SOUTH CHARLESTON, WV 25309
(304) 766-7140
(304) 766-7180
Mailing address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 414-4800
(304) 414-4801
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
10600
WV
2086S0129X
Vascular Surgery Physician
10600
WV
Other
Enumeration date
06/22/2005
Last updated
12/22/2021
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