Provider Demographics
NPI:1295752657
Name:MICHAUD, JEAN PIERRE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:PIERRE
Last Name:MICHAUD
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0040
Mailing Address - Country:US
Mailing Address - Phone:207-498-2359
Mailing Address - Fax:207-498-3947
Practice Address - Street 1:163 VAN BUREN RD
Practice Address - Street 2:ORTHOPEDIC SERVICES
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3567
Practice Address - Country:US
Practice Address - Phone:207-493-5791
Practice Address - Fax:207-498-1326
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12239207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4286074OtherAETNA
1295752657OtherANTHEM BC/BS
10903250OtherCAQH
8481527OtherCIGNA/GREAT WEST HEALTHCARE
MEMD12239OtherMAINE LICENSE
1295752657OtherANTHEM BC/BS