Healthcare Provider Details

I. General information

NPI: 1295752657
Provider Name (Legal Business Name): JEAN PIERRE MICHAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VAN BUREN RD ORTHOPEDIC SERVICES
CARIBOU ME
04736-3567
US

IV. Provider business mailing address

PO BOX 40
CARIBOU ME
04736-0040
US

V. Phone/Fax

Practice location:
  • Phone: 207-493-5791
  • Fax: 207-498-1326
Mailing address:
  • Phone: 207-498-2359
  • Fax: 207-498-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD12239
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: