Bougoulias, Kimberly
Bougoulias, Kimberly is an individual health care provider with primary practice located at 725 Rodel Cv , Lake Mary FL 32746-4859. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Bougoulias, Kimberly can be contacted via phone (407) 302-3130.Contact Information
Primary practice address
725 Rodel Cv
Lake Mary FL 32746-4859
Phone: (407) 302-3130
Fax: (407) 302-3132
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | ME61498 | Florida |
Profile Details
| NPI number | 1457342453 |
|---|---|
| LBN Legal business name | Bougoulias, Kimberly |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 31st, 2005 |
| Last updated | May 18th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457342453 | NPPES |
| Florida | MEDICAID | 375490100 |
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