Healthcare Provider Details

I. General information

NPI: 1619986213
Provider Name (Legal Business Name): MICHAEL JOSEPH CHARBONEAU JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MACOMB ST SUITE 329
MONROE MI
48162-2900
US

IV. Provider business mailing address

1 SEAGATE # 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-5860
  • Fax: 734-240-5899
Mailing address:
  • Phone: 567-585-1983
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101010247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: