Provider Demographics
NPI:1285710665
Name:HOUSER, MICHAEL KENT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENT
Last Name:HOUSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2835
Mailing Address - Country:US
Mailing Address - Phone:636-723-6800
Mailing Address - Fax:636-947-6233
Practice Address - Street 1:330 1ST CAPITOL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2835
Practice Address - Country:US
Practice Address - Phone:636-723-6800
Practice Address - Fax:636-947-6233
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5E87207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202544706Medicaid
MO000003234Medicare ID - Type Unspecified
MOA10642Medicare UPIN