Healthcare Provider Details

I. General information

NPI: 1801896378
Provider Name (Legal Business Name): PIERRE ROSS MICHAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

875 CENTERVILLE RD
WARWICK RI
02886-4381
US

IV. Provider business mailing address

875 CENTERVILLE RD
WARWICK RI
02886-4381
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-4840
  • Fax: 401-828-9570
Mailing address:
  • Phone: 401-828-4840
  • Fax: 401-828-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD10018
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: