Provider Demographics
NPI:1427693761
Name:HORIZON FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:HORIZON FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-385-4342
Mailing Address - Street 1:6060 WILDROSE LN
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4310
Mailing Address - Country:US
Mailing Address - Phone:810-385-4342
Mailing Address - Fax:
Practice Address - Street 1:3041 COMMERCE DR STE B
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3877
Practice Address - Country:US
Practice Address - Phone:810-385-4342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty