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
Fax: (407) 302-3132
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457342453 NPPES
Florida MEDICAID 375490100

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