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General NPI Number Information
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NPI Number | 1043779069
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Entity Type | Individual
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Provider Name | MICHAEL JAMES ELDER LOUTHAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 4445 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-4135
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Country | US
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Telephone | 408-655-7485
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SHELLPRINT CT
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2781
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Country | US
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Telephone | 408-655-7485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A176399
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License Number State | CA
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