Individual
MICHELLE LOUISE GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
9697 SAINT CATHERINES DR, PLEASANT PRAIRIE, WI 53158-2118
(262) 577-8320
(262) 577-8372
Mailing address
9697 SAINT CATHERINES DR, PLEASANT PRAIRIE, WI 53158-2118
(262) 577-8320
(262) 577-8372
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39272
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081091455
MEDICARE RR
WI
05
—
43499900
—
WI
Enumeration date
05/27/2006
Last updated
12/03/2018
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