Provider Demographics
NPI:1568467850
Name:CLOUTIER, VICKIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:MARIE
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 OLD PESHTIGO RD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-3887
Mailing Address - Country:US
Mailing Address - Phone:715-732-8000
Mailing Address - Fax:920-738-5787
Practice Address - Street 1:2310 1ST CENTER AVE
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-1937
Practice Address - Country:US
Practice Address - Phone:608-897-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44889-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI450030594OtherMEDICARE PTAN
34558300OtherEDS
WI34558300Medicaid
700C610000OtherBCBS
700C610000OtherBCBS
M31750021Medicare PIN