Provider Demographics
NPI:1568579696
Name:DUFRESNE, MICHAEL D (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:DUFRESNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SHUMAN AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6020
Mailing Address - Country:US
Mailing Address - Phone:207-307-0958
Mailing Address - Fax:207-512-5909
Practice Address - Street 1:12 SHUMAN AVE STE 6
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6020
Practice Address - Country:US
Practice Address - Phone:207-307-0958
Practice Address - Fax:207-512-5909
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432681799Medicaid
ME000689701Medicare PIN
ME432681799Medicaid
ME000689703Medicare PIN