Individual ProviderCarl BoulosStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address9500 Euclid Ave # Jj24, Cleveland, OH 44195-0001(216) 444-2200PECOS EnrollmentBased on the most recent information from CMS, provider Carl Boulos is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 7:33 AM.Profile DetailsProvider ID1023674397Provider TypeIndividualFull NameBoulos, CarlTitleMr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date5/13/2019Last Updated5/17/2023Contact InformationPractice LocationPractice Address9500 Euclid Ave # Jj24, Cleveland, OH 44195-0001Phone(216) 444-2200FaxUnlisted FaxMailing LocationMailing AddressCleveland Clinic 9500 Euclid Avenue/Jj24, Cleveland, OH 44195-0001Phone(216) 444-2200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerMichigan