Healthcare Provider Details

I. General information

NPI: 1972415834
Provider Name (Legal Business Name): ALEXANDROS BOURAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5302
  • Fax:
Mailing address:
  • Phone: 305-243-4951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTRN46831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: