| Doctor Name: | DR. JOHN MICHAEL HAUTALA |
| NPI Number: | 1174664130 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD00019059 |
| Business Practice Address: | 1033 Regents Blvd Suite 102 Fircrest, WA - 984666045 |
| Business Phone Number: | 2535641115 |
| Business Fax Number: | 2535654552 |
| Mailing Address: | 1033 Regents Blvd, Suite 102 FIRCREST |
| State: | WA |
| Postal Code: | 984666045 |
| Phone Number: | 2535641115 |
| Fax Number: | 2535654552 |
| NPI Enumeration Date: | 02/10/2007 |
| NPI Last Update Date: | 01/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080A0000X |
| License Number: | MD00019059 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |