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MARK BOULOUS
NPI 1912757642
Student in an Organized Health Care Education/Training Program in Peoria, IL

Active since March 25, 2024
530 NE GLEN OAK AVE, PEORIA, IL 61637(309) 655-3863 Get Directions Write a Review

NPPES record last updated: March 25, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mark Boulous NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK BOULOUS (NPI 1912757642) is an individual student in an organized health care education/training program in Peoria, Illinois and active in the NPI registry since March 2024.

NPPES Registry Identity

NPI1912757642
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMARK BOULOUS
Location Address530 NE GLEN OAK AVEPeoria, IL 61637-0001
Mailing Address14 CannesIrvine, CA 92614-5398
Phone(309) 655-3863
Sole ProprietorYes
Enumeration DateMarch 25, 2024
NPPES CertifiedMarch 25, 2024
✔ NPI 1912757642 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
530 NE GLEN OAK AVE, Peoria, IL 61637
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DEEPAK S NAIR M.D.
Psychiatry & Neurology (Neurology)
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
DR. HAMID MAHMOOD ZIA M.D
Pathology (Anatomic Pathology & Clinical Pathology)
530 NE GLEN OAK AVE, CENTRAL ILLINOIS PATHOLOGY SC
PEORIA, IL 61637
Peoria County (309) 624-9011
THOMAS JAMES MCMORROW MD
Pediatrics
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2553
ERIC TYLER AMPARAN MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2274
ALEXANDRA ROPER MD
Surgery
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
JAPMEHR KAUR SANDHU M.B.B.S.
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 624-9351
THOMAS BLACKWELL JR. MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
LUKE KLOFT
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2109

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Boulous's NPI number?

The NPI number for Mark Boulous is 1912757642. It was assigned to this individual provider in the NPPES registry on March 25, 2024.

Where is Mark Boulous located?

Mark Boulous practices at 530 NE Glen Oak Ave, Peoria, IL 61637. The listed phone number is (309) 655-3863.

What is Mark Boulous's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Mark Boulous was last updated on March 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.