Healthcare Provider Details

I. General information

NPI: 1962455972
Provider Name (Legal Business Name): MARION C HAUTEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S BRADLEY HWY
ROGERS CITY MI
49779-2137
US

IV. Provider business mailing address

PO BOX 427
HILLMAN MI
49746-0427
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-2052
  • Fax: 989-734-7390
Mailing address:
  • Phone: 989-742-4583
  • Fax: 989-742-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMH069111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: