Provider Demographics
NPI:1679525539
Name:BOULES, TAMER NADY (MD)
Entity type:Individual
Prefix:
First Name:TAMER
Middle Name:NADY
Last Name:BOULES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 555
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-424-5748
Mailing Address - Fax:248-443-1706
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 555
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-424-5748
Practice Address - Fax:248-443-1706
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010721882086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P33080OtherPTAN
MI4870974Medicaid
MI4870974Medicaid