Provider Demographics
NPI:1881033082
Name:STOUT, MICHAEL PHILIP
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHILIP
Last Name:STOUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14226 CHEVAL MAYFAIRE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7617
Mailing Address - Country:US
Mailing Address - Phone:407-272-1634
Mailing Address - Fax:
Practice Address - Street 1:14226 CHEVAL MAYFAIRE DR APT 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7617
Practice Address - Country:US
Practice Address - Phone:407-272-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS330555752550171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator