Healthcare Provider Details

I. General information

NPI: 1073682324
Provider Name (Legal Business Name): MIKE HOUTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BBD
TAMPA FL
33612
US

IV. Provider business mailing address

1004 HIGHGROVE CT
VALRICO FL
33594-7025
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT6213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: