Healthcare Provider Details

I. General information

NPI: 1407858947
Provider Name (Legal Business Name): MICHEL DUBOIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W 72ND ST APT 1E
NEW YORK NY
10023-3419
US

IV. Provider business mailing address

15 W 72ND ST APT 33E
NEW YORK NY
10023-3473
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-0402
  • Fax: 347-244-7212
Mailing address:
  • Phone: 212-988-0402
  • Fax: 347-244-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number201742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: