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1568467850

NPI Code Detail

MEDICARE: VICKIEMARIE CLOUTIER MD

MEDICARE: VICKIEMARIE CLOUTIER MD

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	44889-020	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	450030594	OTHER	WI	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	34558300	OTHER		EDS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	700C610000	OTHER		BCBS

General Provider Information

NPI Number	:	1568467850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIEMARIE CLOUTIER MD

Provider Business Mailing Address
First Line	:	1300 E GREEN BAY ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-2210
Country	:	US
Telephone Number	:	715-201-0870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E GREEN BAY ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-2210
Country	:	US
Telephone Number	:	715-201-0870
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	04/29/2026

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Directions to “ VICKIEMARIE CLOUTIER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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