MEDICARE: MICHELLE LOUISE GAUTHIER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	39272	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	081091455	OTHER	WI	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265489264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LOUISE GAUTHIER DO

Provider Business Mailing Address
First Line	:	9697 SAINT CATHERINES DR
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-2118
Country	:	US
Telephone Number	:	262-577-8320
Fax Number	:	262-577-8372

Provider Business Practice Location Address
First Line	:	9697 SAINT CATHERINES DR
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-2118
Country	:	US
Telephone Number	:	262-577-8320
Fax Number	:	262-577-8372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/03/2018

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Directions to “ MICHELLE LOUISE GAUTHIER DO” Practice Location

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