MEDICARE: DR. TODD DAVID HOUGLAN M.D.

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	35079612	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811957343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD DAVID HOUGLAN M.D.

Provider Business Mailing Address
First Line	:	9044 CENTER ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8854
Country	:	US
Telephone Number	:	330-769-2941
Fax Number	:	330-769-4804

Provider Business Practice Location Address
First Line	:	9044 CENTER ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8854
Country	:	US
Telephone Number	:	330-769-2941
Fax Number	:	330-769-4804

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	04/10/2008

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