Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Nidal Boutros

Individual provider Internal Medicine Physician · NPI 1629036173

Dr. Nidal Boutros is an Internal Medicine in Lebanon, Missouri. Qualified in 1990, 36 years ago. Practices with Statland Medical Group LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
36
Licensed in
MO
In the registry since
2006

Practice location Address checks out

120 Hospital Dr Ste 300
Lebanon, MO 65536-9238
Phone: (417) 533-6746
Fax: (417) 533-6740
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 2009027847 (MO)

Record details

NPI number1629036173
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 3, 2006
Last updated in NPPESFebruary 10, 2022
Mailing addressPo Box 505164, Saint Louis, MO 63150-5164

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 1990 (36 years in practice)
Group practice Statland Medical Group Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Lebanon