Provider Demographics
NPI:1376109298
Name:FOUTNER, MARGARET CATHERINE
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:CATHERINE
Last Name:FOUTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15591 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1630
Mailing Address - Country:US
Mailing Address - Phone:586-443-6113
Mailing Address - Fax:
Practice Address - Street 1:15591 N PARK AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1630
Practice Address - Country:US
Practice Address - Phone:586-443-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8972877Medicaid