MEDICARE: LISE M 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	207R00000X	Internal Medicine Physician	MD15050	ME

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	:	1386624096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISE M CLOUTIER MD

Provider Business Mailing Address
First Line	:	2 LIVEWELL DR
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6762
Country	:	US
Telephone Number	:	207-467-8988
Fax Number	:	207-467-8969

Provider Business Practice Location Address
First Line	:	2 LIVEWELL DR
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6762
Country	:	US
Telephone Number	:	207-467-8988
Fax Number	:	207-467-8969

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	11/24/2025

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Directions to “ LISE M CLOUTIER MD” Practice Location

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