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1114991577
RIDA W BOULOS
PEORIA, IL
NPI
1114991577
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207V00000X Obstetrics & Gynecology
(Licence: IL 036055246)
Enumeration Date
2006-02-14
Last Update Date
2007-07-09
Business Address
-- RIDA W BOULOS MD
DEPT OF OB / GYN 530 NE GLEN OAK
PEORIA, IL 61637-0001
Phone number: 309-655-3024
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Mailing Address
-- RIDA W BOULOS MD
1 ILLINI DR
PEORIA, IL 61605-2576
Phone number: 309-671-8503
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