Provider Demographics
NPI:1750373833
Name:CLOUSE, TROY D (MD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:D
Last Name:CLOUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAST BLVD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2483
Mailing Address - Country:US
Mailing Address - Phone:574-523-3161
Mailing Address - Fax:574-523-3221
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-3161
Practice Address - Fax:574-523-3221
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053909207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104311635Medicaid
IN930106366OtherRAIL ROAD MEDICARE
IN000000196952OtherANTHEM
IN200332130Medicaid
IN930106366OtherRAIL ROAD MEDICARE
INH38309Medicare UPIN