Healthcare Provider Details

I. General information

NPI: 1104250158
Provider Name (Legal Business Name): BE WELL MY FRIEND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHUMAN AVE STE 6
AUGUSTA ME
04330-6020
US

IV. Provider business mailing address

12 SHUMAN AVE STE 6
AUGUSTA ME
04330-6020
US

V. Phone/Fax

Practice location:
  • Phone: 207-307-0958
  • Fax: 207-512-5909
Mailing address:
  • Phone: 207-307-0958
  • Fax: 207-512-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2105
License Number StateME

VIII. Authorized Official

Name: DR. MICHAEL D DUFRESNE
Title or Position: OWNER
Credential: DO
Phone: 207-307-0958