Provider Demographics
NPI:1891054003
Name:MICHEL LIRETTE MD LLC
Entity Type:Organization
Organization Name:MICHEL LIRETTE MD LLC
Other - Org Name:MICHEL LIRETTE MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CROTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-681-4505
Mailing Address - Street 1:203 TURNPIKE ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5042
Mailing Address - Country:US
Mailing Address - Phone:978-681-4505
Mailing Address - Fax:978-681-4507
Practice Address - Street 1:203 TURNPIKE ST
Practice Address - Street 2:SUITE 115
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5042
Practice Address - Country:US
Practice Address - Phone:978-681-4505
Practice Address - Fax:978-681-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QB0400X
MA76941261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ13903OtherBLUESHIELD OF MASSACHUSETTS
MAM17018OtherBLUESHIELD OF MASSACHUSETTS
MA3110541Medicaid
MA13002OtherHARVARDPILGRIM HEALTHCARE
MA730461OtherTUFTS HEALTH CARE
MA9784802Medicaid
MA9784802Medicaid