Provider Demographics
NPI:1952575573
Name:PAYETTE, MICHAEL J (MD, MBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PAYETTE
Suffix:
Gender:M
Credentials:MD, MBA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 WILLOWBROOK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1745
Mailing Address - Country:US
Mailing Address - Phone:860-322-2222
Mailing Address - Fax:860-322-6838
Practice Address - Street 1:1 WILLOWBROOK RD STE 2
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1745
Practice Address - Country:US
Practice Address - Phone:860-322-2222
Practice Address - Fax:860-322-6838
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT050974207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology