Provider Demographics
NPI:1356406680
Name:CLOUSE, PAUL J (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:CLOUSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8187 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:VESTABURG
Mailing Address - State:MI
Mailing Address - Zip Code:48891-9556
Mailing Address - Country:US
Mailing Address - Phone:989-427-3331
Mailing Address - Fax:989-427-3037
Practice Address - Street 1:223 W. MAIN ST.
Practice Address - Street 2:PO 79
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829
Practice Address - Country:US
Practice Address - Phone:989-427-3331
Practice Address - Fax:989-427-3037
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN83930002Medicare PIN
MIP53421Medicare UPIN