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

Mark Boulous

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1912757642

Mark Boulous is a Student in an Organized Health Care Education/Training Program in Peoria, Illinois. Practices as a sole proprietor. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 655-3863
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1912757642
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 25, 2024
Last updated in NPPESMarch 25, 2024
Certification dateMarch 25, 2024
Mailing address14 Cannes, Irvine, CA 92614-5398

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