MEDICARE: MICHAEL GENE CLOUTIER M.D.

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	2085R0202X	Diagnostic Radiology Physician	26916	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300033903	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	23149	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1598743643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GENE CLOUTIER M.D.

Provider Business Mailing Address
First Line	:	1331 N ELM ST
Second Line	:	SUITE 200
City	:	GREENSBORO
State	:	NC
Zip	:	27401-6302
Country	:	US
Telephone Number	:	336-274-9617
Fax Number	:	336-482-2177

Provider Business Practice Location Address
First Line	:	1331 N ELM ST
Second Line	:	SUITE 200
City	:	GREENSBORO
State	:	NC
Zip	:	27401-6302
Country	:	US
Telephone Number	:	336-274-9617
Fax Number	:	336-482-2177

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

Provider Enumeration Date	:	01/08/2006
Last Update Date	:	03/18/2014

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Directions to “ MICHAEL GENE CLOUTIER M.D.” Practice Location

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