MEDICARE: DR. ILENE BOUDREAUX M.D.

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	208000000X	Pediatrics Physician	C10003341	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568473486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILENE BOUDREAUX M.D.

Provider Business Mailing Address
First Line	:	3521 SILVERSIDE RD
Second Line	:	1F QUILLEN BLDG
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4900
Country	:	US
Telephone Number	:	302-479-5505
Fax Number	:	302-478-2637

Provider Business Practice Location Address
First Line	:	3521 SILVERSIDE RD
Second Line	:	1F QUILLEN BLDG
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4900
Country	:	US
Telephone Number	:	302-479-5505
Fax Number	:	302-478-2637

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ILENE BOUDREAUX M.D.” Practice Location

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