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Contact Information

MIREILLE N BOUTRY, MD
11100 EUCLID AVE
CLEVELAND, OH44106-1716
 Phone: 216-844-7700
 Fax: 216-286-6341
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MIREILLE N BOUTRY · (Female)

NPI Number 1932127750
Status Active
Credentials MD
Entity Individual
Enumeration date 07/18/2006
Last updated 06/30/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • OH License # 35-060531
  • OH Medicaid 0822695
  • OH Other 0635168 AETNA
  • OH Other 000000027989 ANTHEM
  • OH Other 000000525909 ANTHEM
  • OH Other 0822695 BCMH
  • OH Other 738036 BUCKEYE
  • OH Other 370001902 RAILROAD MEDICARE
  • OH Other 000000220998 UNISON
  • OH Other 363375 WELLCARE
  • PA Other 1011820810001 PA MEDICAID
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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