Michael M Boustany MD Inc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

10600 Issued in WV

Legal business name

MICHAEL M BOUSTANY MD INC

Practice address

415 Morris St
Ste 105
Charleston, WV 25301-1840

Phone

(304) 343-7557

Fax

(304) 343-3441

NPI assigned

Jun 22, 2005

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael M Boustany, MD

Title

Owner

Phone

(304) 343-7557

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ahmad Bali, MD

  • Surgery Physician
  • Charleston, WV
  • NPI 1689670069
  NPD (past)
• Daniel L Stickler II, M.D.

  • General Practice Physician
  • Driftwood, TX
  • NPI 1346295698
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1326044710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3850",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253383850",
            "telephone_number": "304-233-9314",
            "fax_number": "304-233-0265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST",
            "address_2": "STE 105",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011840",
            "telephone_number": "304-343-7557",
            "fax_number": "304-343-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL M BOUSTANY MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BOUSTANY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-343-7557",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WV",
            "license": "10600",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WV",
            "license": "10600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2065901",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6953086900",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley E Meyer, D.O
• Zachary Meyer, DO
• Farhat S Mian, MD
• Muhammad S Mian, MD
• D Rachelle Miano, AU.D.
• Rebecca Michael
• Susan Jayne Mick
• Virginia Mick
• Elaina Mickel
• Dorothy Midcap

• Vascular Surgery Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Vascular Surgery Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.