Provider Demographics
NPI:1750356291
Name:HOUNTRAS, DEAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MICHAEL
Last Name:HOUNTRAS
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 1:4629 CINNAMON LANE
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-471-0048
Mailing Address - Fax:419-471-1307
Practice Address - Street 1:4629 CINNAMON LANE
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-471-0048
Practice Address - Fax:419-471-1307
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0666402085R0202X
MI43010510312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE88250Medicare UPIN
OH0876564Medicare ID - Type Unspecified