Michael C Dussault, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

21659 Issued in WI

Practice address

248 McHenry St
Burlington, WI 53105-1828

Phone

(262) 767-8256

Fax

(262) 767-8212

NPI assigned

Aug 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1285749440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-647-6326",
            "fax_number": "414-671-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "531051828",
            "telephone_number": "262-767-8256",
            "fax_number": "262-767-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUSSAULT",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "21659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30248900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Burlington, WI
• Providers in Burlington, WI by specialty
• Orthopaedic Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.