Healthcare Provider Details

I. General information

NPI: 1740220250
Provider Name (Legal Business Name): MICHELLE JULENE LEFEBVRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST SUITE 190
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

67 ORIOLE AVE
PROVIDENCE RI
02906-5527
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3400
  • Fax: 401-444-3411
Mailing address:
  • Phone: 401-464-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD09918
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberM.D.09918
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD09918
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: