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General NPI Number Information
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NPI Number | 1568923712
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Entity Type | Individual
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Provider Name | ALEXANDER BOULOS MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 8390 W FLAGLER ST STE 201
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City | MIAMI
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State | FL
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Zip | 33144-2039
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Country | US
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Telephone | 305-747-3846
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Fax |
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Provider Business Mailing Address
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Address Line | 8390 W FLAGLER ST STE 201
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City | MIAMI
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State | FL
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Zip | 33144-2039
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Country | US
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Telephone | 305-747-3846
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 323286
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME174086
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License Number State | FL
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