MEDICARE: AMINE BOURI

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1811365208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINE BOURI

Provider Business Mailing Address
First Line	:	11532 WESTWOOD BLVD APT 615
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-7398
Country	:	US
Telephone Number	:	321-946-3584
Fax Number	:

Provider Business Practice Location Address
First Line	:	10156 LOVE STORY ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-1758
Country	:	US
Telephone Number	:	321-946-3584
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	10/08/2019

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