Basic Information
| Provider Information | |||||||||
| NPI: | 1376597757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSER | ||||||||
| FirstName: | KEIM | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 N LAFAYETTE BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742322037 | ||||||||
| FaxNumber: | 5742321420 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 N LAFAYETTE BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742322037 | ||||||||
| FaxNumber: | 5742321420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01022611A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100220030A | 05 | IN | MEDICAID |