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Michael James Elder Louthan

Emergency Medicine

Allopathic & Osteopathic Physicians

4445 Magnolia Ave, Riverside, CA 92501-4135

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL LOUTHAN.

Based on the most recent information from CMS, provider Michael James Elder Louthan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1043779069
Provider Type
Individual
Full Name
Louthan, Michael James Elder
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/19/2019
Last Updated
6/1/2022

Contact Information

Practice Location

4445 Magnolia Ave, Riverside, CA 92501-4135

(408) 655-7485

Unlisted Fax

Mailing Location

6 Shellprint Ct, Newport Beach, CA 92663-2781

(408) 655-7485

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License A176399 California
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Michael James Elder Louthan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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