MEDICARE: DOLLY ALBERT BOUGHABA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	01072116A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000804952	OTHER	IN	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376582221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLLY ALBERT BOUGHABA MD

Provider Business Mailing Address
First Line	:	405 SOUTHWIND LN
Second Line	:
City	:	LUDLOW
State	:	KY
Zip	:	41016-1715
Country	:	US
Telephone Number	:	513-470-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 SOUTHWIND LN
Second Line	:
City	:	LUDLOW
State	:	KY
Zip	:	41016-1715
Country	:	US
Telephone Number	:	513-470-2777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	05/20/2025

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Directions to “ DOLLY ALBERT BOUGHABA MD” Practice Location

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