MEDICARE: JENNIFER HOUTMAN MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	JH075631	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA1068	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	JH075631	OTHER	MI	STATE LICENSE #
3	23904	OTHER	MI	HEALTH PLAN OF MI
4	P25914F	OTHER	MI	BLUE CARE NETWORK
5	01-31681	OTHER		PHP PROV #
6	2334854	OTHER		UNITED HEALTHCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750372033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HOUTMAN MD

Provider Business Mailing Address
First Line	:	4613 W MAIN ST
Second Line	:	STE A
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2698
Country	:	US
Telephone Number	:	269-349-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 W MAIN ST
Second Line	:	SUITE A
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2645
Country	:	US
Telephone Number	:	269-488-8672
Fax Number	:	269-488-8673

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	06/08/2016

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Directions to “ JENNIFER HOUTMAN MD” Practice Location

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