Provider Demographics
NPI:1255330924
Name:HOUCK, VERLIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:VERLIN
Middle Name:T
Last Name:HOUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:2102 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-9310
Practice Address - Country:US
Practice Address - Phone:574-862-2165
Practice Address - Fax:574-862-4112
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030219A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100382520Medicaid
IN236040019OtherMEDICARE PTAN
IN080118727 RR MED#Medicare PIN
IN236040019OtherMEDICARE PTAN
IN100382520Medicaid