Healthcare Provider Details

I. General information

NPI: 1083619928
Provider Name (Legal Business Name): JEFFREY J MICHAUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 FAUNCE CORNER RD
DARTMOUTH MA
02747-1242
US

IV. Provider business mailing address

531 FAUNCE CORNER RD
DARTMOUTH MA
02747-1242
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3991
  • Fax:
Mailing address:
  • Phone: 508-996-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number159090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: