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General NPI Number Information
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NPI Number | 1518904093
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Entity Type | Individual
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Provider Name | NASHAAT N BOUTROS MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 440 LAKE COOK RD STE 2
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City | DEERFIELD
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State | IL
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Zip | 60015
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Country | US
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Telephone | 847-945-6463
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Fax | 847-945-6469
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Provider Business Mailing Address
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Address Line | 440 LAKE COOK RD STE 2
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City | DEERFIELD
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State | IL
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Zip | 60015-5263
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Country | US
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Telephone | 847-945-6463
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Fax | 847-945-6469
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.061302
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License Number State | IL
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