MEDICARE: MICHAEL D DUFRESNE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2068	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568579696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D DUFRESNE DO

Provider Business Mailing Address
First Line	:	12 SHUMAN AVE STE 6
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-6020
Country	:	US
Telephone Number	:	207-307-0958
Fax Number	:	207-512-5909

Provider Business Practice Location Address
First Line	:	12 SHUMAN AVE STE 6
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-6020
Country	:	US
Telephone Number	:	207-307-0958
Fax Number	:	207-512-5909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	04/01/2024

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Directions to “ MICHAEL D DUFRESNE DO” Practice Location

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