Provider Demographics
NPI:1497756415
Name:CLOUATRE, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CLOUATRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8702
Mailing Address - Country:US
Mailing Address - Phone:479-582-9268
Mailing Address - Fax:479-973-9229
Practice Address - Street 1:5330 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8702
Practice Address - Country:US
Practice Address - Phone:479-582-9268
Practice Address - Fax:479-973-9229
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1371207V00000X
LA24058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131536001Medicaid
AR131536001Medicaid
5K449Medicare ID - Type Unspecified