Healthcare Provider Details

I. General information

NPI: 1275635047
Provider Name (Legal Business Name): MICHAEL ANTONY JUKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ABNER POINT RD
BAILEY ISLAND ME
04003-2540
US

IV. Provider business mailing address

119 ABNER POINT RD
BAILEY ISLAND ME
04003-2540
US

V. Phone/Fax

Practice location:
  • Phone: 727-455-0333
  • Fax:
Mailing address:
  • Phone: 727-455-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberNH5161
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: