Provider Demographics
NPI:1407858947
Name:DUBOIS, MICHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 72ND ST
Mailing Address - Street 2:APT 33E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3473
Mailing Address - Country:US
Mailing Address - Phone:212-988-0402
Mailing Address - Fax:347-244-7212
Practice Address - Street 1:15 W 72ND ST APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3419
Practice Address - Country:US
Practice Address - Phone:212-988-0402
Practice Address - Fax:347-244-7212
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201742207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02111604Medicaid
NY02111604Medicaid
NYC69004Medicare UPIN