MEDICARE: DR. MARK E. MICHAUD 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
1	207Q00000X	Family Medicine Physician	0101256394	VA
2	207Q00000X	Family Medicine Physician	L023430	LA
3	207Q00000X	Family Medicine Physician	2017-00185	NC

General Provider Information

NPI Number	:	1588643597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E. MICHAUD M.D.

Provider Business Mailing Address
First Line	:	2511 OLD CORNWALLIS RD STE 200
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-1869
Country	:	US
Telephone Number	:	919-932-5700
Fax Number	:	919-933-6881

Provider Business Practice Location Address
First Line	:	530 NEW WAVERLY PL STE 101
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-7414
Country	:	US
Telephone Number	:	919-650-6066
Fax Number	:	919-882-1378

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/29/2021

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