Individual
DR. MARCIA K. HAUTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1302 FRANKLIN AVE LOWR LEVEL, NORMAL, IL 61761-3551
(309) 451-2920
Mailing address
PO BOX 2451, BLOOMINGTON, IL 61702-2451
(309) 268-2172
(309) 268-3649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5715395
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/18/2006
Last updated
07/08/2007
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