Healthcare Provider Details

I. General information

NPI: 1508023466
Provider Name (Legal Business Name): NICHOLAS HOULIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-1373
US

IV. Provider business mailing address

2711 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-1373
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-0302
  • Fax: 407-380-5127
Mailing address:
  • Phone: 407-380-0302
  • Fax: 407-380-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA09220800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberOS16566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: