Healthcare Provider Details

I. General information

NPI: 1235252461
Provider Name (Legal Business Name): R MICHELLE CHOUTEAU MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 MEDICAL ARTS ST STE 19A
AUSTIN TX
78705-3376
US

IV. Provider business mailing address

2911 MEDICAL ARTS ST STE 19A
AUSTIN TX
78705-3376
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-1954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. R MICHELLE CHOUTEAU
Title or Position: PRINCIPAL
Credential: MD
Phone: 512-477-9156