Provider Demographics
NPI:1356501340
Name:BOULIS, THARWAT STEWART FOUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:THARWAT STEWART
Middle Name:FOUAD
Last Name:BOULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1440 PLEASANT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1728
Mailing Address - Country:US
Mailing Address - Phone:515-309-6011
Mailing Address - Fax:515-309-6014
Practice Address - Street 1:1440 PLEASANT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1728
Practice Address - Country:US
Practice Address - Phone:515-309-6011
Practice Address - Fax:515-309-6014
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD433096207V00000X
MS20151207V00000X
IAMD-41817207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology