Individual provider · NPI-1

Dr. Michael S Bouton, MD

Surgery · Fargo, ND

NPI number1356336358
StatusActive
Last updated in NPPESMar 25, 2022

Details

NPI
1356336358
Entity type
Individual (NPI-1)
Name
Dr. Michael S Bouton
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Sep 15, 2005
Certification date
Mar 25, 2022
Last updated
Mar 25, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208600000X Surgery10920NDYes
208600000X SurgeryR4107AR
208600000X SurgeryG9329TX

Practice location

801 Broadway N
Fargo, ND 58102-3641

Phone 701-234-2251 · Fax 701-234-2050

Mailing address

Po Box 2010
Fargo, ND 58122-0605

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