Healthcare Provider Details

I. General information

NPI: 1952380487
Provider Name (Legal Business Name): ERIC WILLIAM HOUK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MCEWAN ST
CLARE MI
48617-1440
US

IV. Provider business mailing address

703 N MCEWAN ST
CLARE MI
48617-1440
US

V. Phone/Fax

Practice location:
  • Phone: 989-802-5000
  • Fax:
Mailing address:
  • Phone: 989-802-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704202193
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: