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General NPI Number Information
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NPI Number | 1104092337
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Entity Type | Organization
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Legal Business Name | MICHAEL J CHARBONEAU JR DO PLLC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 730 N MACOMB ST SUITE 329
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City | MONROE
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State | MI
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Zip | 48162-2900
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Country | US
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Telephone | 734-241-4245
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Fax | 734-242-8903
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Provider Business Mailing Address
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Address Line | 730 N MACOMB ST SUITE 329
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City | MONROE
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State | MI
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Zip | 48162-2900
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Country | US
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Telephone | 734-241-4245
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Fax | 734-242-8903
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOSEPH CHARBONEAU JR.
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Credential | DO
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Telephone | 734-241-4245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101010247
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License Number State | MI
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