Provider Demographics
NPI:1396718680
Name:DROULETTE, MICHAEL R (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:DROULETTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 ODELL FARMS CT
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-4106
Mailing Address - Country:US
Mailing Address - Phone:301-595-7327
Mailing Address - Fax:202-833-5762
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:SUITE #203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:202-347-3296
Practice Address - Fax:202-833-5762
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00527174400000X
DCP0350213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7222-0001OtherCAREFIRST-BS ID#
DC1815-0001OtherCAREFIRST-BS ID#
T31038Medicare UPIN
DC696949Medicare ID - Type Unspecified
MD185570Medicare ID - Type Unspecified