Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1462-39 | WI |
Y | 213ES0000X | Sports Medicine | 1462-39 | WI |
NPI | 1477021640 |
---|---|
Provider Name | Michael Houte |
First Address | Milwaukee, WI 53202-2507 |
Second Address | Milwaukee, WI 53202-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |