Healthcare Provider Details

I. General information

NPI: 1588862486
Provider Name (Legal Business Name): MICHELLE MARIE PRIMEAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S. MARY AVE SUITE 200
SUNNYVALE CA
94087-3060
US

IV. Provider business mailing address

2350 W. EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 408-523-3460
  • Fax:
Mailing address:
  • Phone: 408-523-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMT190573
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA116353
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA116353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: