| Doctor Name: | DR. MARYLISE BOUTROS |
| NPI Number: | 1568777191 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. FRCS |
| License Number: | TRN15351 |
| Business Practice Address: | 2950 Cleveland Clinic Blvd Weston, FL - 333313609 |
| Business Phone Number: | 9546595757 |
| Business Fax Number: | |
| Mailing Address: | 16380 S Post Rd, Apt 102 WESTON |
| State: | FL |
| Postal Code: | 333313557 |
| Phone Number: | 9546327672 |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2010 |
| NPI Last Update Date: | 08/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208C00000X |
| License Number: | TRN15351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Colon & Rectal Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. |