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General NPI Number Information
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NPI Number | 1225590169
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Entity Type | Individual
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Provider Name | MICHAEL BOULOUS MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 317-944-2621
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Fax |
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Provider Business Mailing Address
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Address Line | 9998 CROSSPOINT BLVD STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3307
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Country | US
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Telephone | 317-579-2150
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Fax | 317-806-8296
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01086907A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01086907A
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License Number State | IN
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