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NPI Code Detail

MEDICARE: DR. MICHAEL R. ST JEAN M.D.

MEDICARE:  DR. MICHAEL R. ST JEAN  M.D.
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
1208600000XSurgery Physician68165-20WI

General Provider Information

NPI Number : 1578511689
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL R. ST JEAN M.D.
Provider Business Mailing Address
First Line : 1843 MICHIGAN ST
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1007
Country : US
Telephone Number : 207-973-8881
Fax Number : 207-973-8880
Provider Business Practice Location Address
First Line : 1843 MICHIGAN ST
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1007
Country : US
Telephone Number : 920-746-1060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 11/09/2023

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Directions to “ DR. MICHAEL R. ST JEAN M.D.” Practice Location

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