Healthcare Provider Details

I. General information

NPI: 1538158464
Provider Name (Legal Business Name): STEPHEN J. MICHAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17A TATRO RD SUITE 201
GOFFSTOWN NH
03045-2370
US

IV. Provider business mailing address

17A TATRO RD SUITE 201
GOFFSTOWN NH
03045-2370
US

V. Phone/Fax

Practice location:
  • Phone: 603-314-4500
  • Fax: 603-314-4504
Mailing address:
  • Phone: 603-314-4500
  • Fax: 603-314-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11384
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: