MEDICARE: MR. PAUL E HOUK PA-C

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	85-000937	IL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85-000937	OTHER	IL	STATE LICENSE NUMBER
2	1034360	OTHER	IL	NCCPA-NAT. COM CERT OF PA
3	385-000531	OTHER	IL	PA CONTROLLED SUBSTANCE
4	1112	OTHER	IA	STATE LICENSE
5	5100395	OTHER	IA	STATE CONTROLLED SUBSTANC
6	552	OTHER	TN	STATE LICENSE

NPI Number	:	1144221425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL E HOUK PA-C

Provider Business Mailing Address
First Line	:	1025 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2403
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:	217-525-3664

Provider Business Practice Location Address
First Line	:	1025 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2403
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:	217-528-7541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/07/2023

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039