Provider Demographics
NPI:1023015674
Name:HAUT, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:HAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 HARRISON AVE NW
Mailing Address - Street 2:STE 105
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2609
Mailing Address - Country:US
Mailing Address - Phone:330-453-9993
Mailing Address - Fax:330-453-9996
Practice Address - Street 1:1455 HARRISON AVE NW
Practice Address - Street 2:STE 105
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2609
Practice Address - Country:US
Practice Address - Phone:330-453-9993
Practice Address - Fax:330-453-9996
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-11-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5161207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0762474Medicaid
OHE61384Medicare UPIN
OH0762474Medicaid
CE9421Medicare PIN
OHHA0707964Medicare PIN