Provider Demographics
NPI:1386092872
Name:HOUCHINS, MARYKATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MARYKATHERINE
Middle Name:
Last Name:HOUCHINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARYKATHERINE
Other - Middle Name:
Other - Last Name:MOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:B1 FLOOR TAUBMAN CENTER RECP MOS RM 126
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5317
Practice Address - Country:US
Practice Address - Phone:734-232-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant