Provider Demographics
NPI:1437247491
Name:HOUSTON, THOMAS MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:HOUSTON
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 1:5755 MONCLOVA RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1837
Mailing Address - Country:US
Mailing Address - Phone:419-893-2663
Mailing Address - Fax:419-893-7941
Practice Address - Street 1:5755 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1837
Practice Address - Country:US
Practice Address - Phone:419-893-2663
Practice Address - Fax:419-893-7941
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH44190207X00000X
MI4301039592207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000285862OtherANTHEM
OH200044058OtherCHAMPUS
OH200044058OtherRAILROAD MEDICARE
OH00778OtherPARAMOUNT
OHP00648106OtherRRMC
OH0419283Medicaid
OH4002451OtherAETNA
OH00778OtherPARAMOUNT
OHP00648106OtherRRMC
OHE95968Medicare UPIN