Healthcare Provider Details

I. General information

NPI: 1598727117
Provider Name (Legal Business Name): MICHEL LIRETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 TURNPIKE STREET SUITE 115
N ANDOVER MA
01845
US

IV. Provider business mailing address

203 TURNPIKE STREET SUITE 115
NORTH ANDOVER MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 978-681-4505
  • Fax: 978-681-4507
Mailing address:
  • Phone: 978-681-4505
  • Fax: 978-681-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number76941
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: