Provider Demographics
NPI:1538158423
Name:CLOUKEY, LAURA T (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:T
Last Name:CLOUKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-1720
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:2485 PINELLAS PL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2703
Practice Address - Country:US
Practice Address - Phone:352-674-1720
Practice Address - Fax:352-674-8920
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS12801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
079309OtherTUFTS ASSOCIATED HEALTH P
MA3122271Medicaid
MA000000020218OtherBOSTON HEALTH NET
B10159801OtherCIGNA HEALTHCARE
110231259OtherRAILROAD MEDICARE
473570OtherAETNA/US HEALTHCARE
MA0001190OtherNEIGHBORHOOD HEALTH PLAN
MA64359OtherHARVARD PILGRIM
MAJ30429OtherBLUE CROSS/BLUE SHIELD
MAF78494Medicare UPIN
MACLJ30429Medicare ID - Type Unspecified