Provider Demographics
NPI:1922419407
Name:BOULOS, ANDREW KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KAMAL
Last Name:BOULOS
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 1:7010 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4249
Mailing Address - Country:US
Mailing Address - Phone:386-562-8500
Mailing Address - Fax:256-827-5067
Practice Address - Street 1:7010 BROOKSHIRE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4249
Practice Address - Country:US
Practice Address - Phone:386-562-8500
Practice Address - Fax:256-827-5067
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS47332080P0204X, 2080P0204X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program