Basic Information
| Provider Information | |||||||||
| NPI: | 1437247491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5755 MONCLOVA RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198932663 | ||||||||
| FaxNumber: | 4198937941 | ||||||||
| Practice Location | |||||||||
| Address1: | 5755 MONCLOVA RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198932663 | ||||||||
| FaxNumber: | 4198937941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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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 | 207X00000X | 44190 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 4301039592 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000000285862 | 01 | OH | ANTHEM | OTHER | 200044058 | 01 | OH | CHAMPUS | OTHER | 200044058 | 01 | OH | RAILROAD MEDICARE | OTHER | 00778 | 01 | OH | PARAMOUNT | OTHER | P00648106 | 01 | OH | RRMC | OTHER | 0419283 | 05 | OH | MEDICAID | 4002451 | 01 | OH | AETNA | OTHER |