Healthcare Provider Details

I. General information

NPI: 1174685499
Provider Name (Legal Business Name): RAYMOND D HAUTAMAKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1843 FLOYD STREET
SARASOTA FL
34239
US

IV. Provider business mailing address

1843 FLOYD STREET
SARASOTA FL
34239
US

V. Phone/Fax

Practice location:
  • Phone: 941-951-3920
  • Fax: 941-951-3922
Mailing address:
  • Phone: 941-951-3920
  • Fax: 941-951-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME59585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: