Provider Demographics
NPI:1861981763
Name:BOULIS, MARWAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:
Last Name:BOULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5220 HIGHLAND RD STE 230
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1973
Mailing Address - Country:US
Mailing Address - Phone:248-254-8900
Mailing Address - Fax:248-599-7191
Practice Address - Street 1:5220 HIGHLAND RD STE 230
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1973
Practice Address - Country:US
Practice Address - Phone:248-254-8900
Practice Address - Fax:248-599-7191
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301509067207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology