Healthcare Provider Details

I. General information

NPI: 1851309553
Provider Name (Legal Business Name): R MICHELLE CHOUTEAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 32ND ST SUITE 516
AUSTIN TX
78705-2707
US

IV. Provider business mailing address

2911 MEDICAL ARTS ST SUITE 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 NumberH1356
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: