Provider Demographics
NPI:1902045990
Name:BOUTROS, VERA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERA
Middle Name:
Last Name:BOUTROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E RAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4359
Mailing Address - Country:US
Mailing Address - Phone:224-526-8346
Mailing Address - Fax:847-503-9752
Practice Address - Street 1:1845 E RAND RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4359
Practice Address - Country:US
Practice Address - Phone:847-254-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128848202K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine