Michael J Charboneau Jr DO PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5101010247 Issued in MI

Legal business name

MICHAEL J CHARBONEAU JR DO PLLC

Practice address

730 N Macomb St
Suite 329
Monroe, MI 48162-2900

Phone

(734) 241-4245

Fax

(734) 242-8903

NPI assigned

May 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Joseph Charboneau Jr., DO

Title

Owner

Phone

(734) 241-4245

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1104092337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 N MACOMB ST",
            "address_2": "SUITE 329",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481622900",
            "telephone_number": "734-241-4245",
            "fax_number": "734-242-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N MACOMB ST",
            "address_2": "SUITE 329",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481622900",
            "telephone_number": "734-241-4245",
            "fax_number": "734-242-8903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J CHARBONEAU JR DO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-07",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "CHARBONEAU",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-241-4245",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101010247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0255810524",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4218443",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Monroe, MI
• Providers in Monroe, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.