Provider Demographics
NPI:1619986213
Name:CHARBONEAU, MICHAEL JOSEPH JR (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:CHARBONEAU
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:# 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1983
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:SUITE 329
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2900
Practice Address - Country:US
Practice Address - Phone:734-240-5860
Practice Address - Fax:734-240-5899
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-11-03
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Provider Licenses
StateLicense IDTaxonomies
MI5101010247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG22695OtherHAP
MI11684OtherHEALTH PLAN OF MICHIGAN
MI0255810524OtherBLUE CARE NETWORD
MI020046979OtherRAIL ROAD MEDICARE
MI4218443Medicaid
MI0255810524OtherBLUE CROSS BLUE SHIELD
MI11684OtherHEALTH PLAN OF MICHIGAN
MI0N12480Medicare ID - Type Unspecified