Provider Demographics
NPI:1801863113
Name:HOUGHTON, NANCY (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13829 HAMILTON
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48192
Mailing Address - Country:US
Mailing Address - Phone:248-737-1820
Mailing Address - Fax:248-737-1820
Practice Address - Street 1:23901 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-6035
Practice Address - Country:US
Practice Address - Phone:248-357-3360
Practice Address - Fax:248-737-1820
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010411207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI050F355980OtherBCBSMI PIN
MI050058829OtherMR RAILROAD
MI3469609-11Medicaid
MI0P57180001Medicare PIN
MI050058829OtherMR RAILROAD
MI050F355980OtherBCBSMI PIN