SearchIllinois390200000X

Mark Boulous

NPI 1912757642 · on the registry since 2024 · sole proprietor

Practice

Address
530 Ne Glen Oak Ave
Peoria, IL 61637
Phone
(309) 655-3863
Organisation at this address
University Of Illinois
University Of Illinois
St. Francis Medical Center
Saint Francis Medical Center
Saint Francis Medical Center
Inferred from a shared address, not stated in the registry.
Clinicians at this address
1,001

Registry record

Primary taxonomy
390200000X
390200000X
Sex
Male
Record last updated
2024-03-25

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois