Provider Demographics
NPI:1407885213
Name:MICHAUD, JEFFREY S (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:15 MOLLISON WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5805
Practice Address - Country:US
Practice Address - Phone:207-777-4440
Practice Address - Fax:207-777-8197
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-07-20
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Provider Licenses
StateLicense IDTaxonomies
MEDO1637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME285540099Medicaid
MEMM9056Medicare PIN
ME285540099Medicaid