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General NPI Number Information
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NPI Number | 1417376013
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Entity Type | Individual
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Provider Name | MICHAEL BOURLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 6 CARE LN
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-8651
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Country | US
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Telephone | 518-581-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 TULANE AVE. SL-50
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2699
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Country | US
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Telephone | 504-988-7809
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Fax | 504-988-3971
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 383734
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License Number State | NY
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