Provider Demographics
NPI:1750761383
Name:CLOOS, MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:CLOOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 11TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1292
Mailing Address - Country:US
Mailing Address - Phone:563-659-6090
Mailing Address - Fax:866-493-4063
Practice Address - Street 1:1415 11TH ST STE C
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1292
Practice Address - Country:US
Practice Address - Phone:563-659-6090
Practice Address - Fax:866-493-4063
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty