Provider Demographics
NPI:1477021640
Name:HOUTE, MICHAEL (LAT, CSCS, PES, CES)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOUTE
Suffix:
Gender:M
Credentials:LAT, CSCS, PES, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2507
Mailing Address - Country:US
Mailing Address - Phone:262-237-4269
Mailing Address - Fax:
Practice Address - Street 1:1245 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2507
Practice Address - Country:US
Practice Address - Phone:262-237-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1462-392081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine