MEDICARE: DR. VERA BOUTROS 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	207Q00000X	Family Medicine Physician	036128848	IL
2	202K00000X	Phlebology Physician	036128848	IL

General Provider Information

NPI Number	:	1902045990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERA BOUTROS M.D.

Provider Business Mailing Address
First Line	:	1845 E RAND RD STE 100
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4359
Country	:	US
Telephone Number	:	224-526-8346
Fax Number	:	847-503-9752

Provider Business Practice Location Address
First Line	:	1845 E RAND RD STE 100
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4359
Country	:	US
Telephone Number	:	224-526-8346
Fax Number	:

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

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	11/22/2024

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