Kervin Michaud, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN26380 Issued in FL

Practice address

1085 N John Young Pkwy
Kissimmee, FL 34741-4210

Phone

(407) 483-5797

NPI assigned

Aug 19, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 28, 2022 through Jan 28, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alan D Shoopak DMD Orthodontic Group VI LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Kissimmee, FL
  • NPI 1407145717
  NPD (past)

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1295401206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 10TH AVE N APT A",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334602203",
            "telephone_number": "561-628-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 N JOHN YOUNG PKWY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414210",
            "telephone_number": "407-483-5797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHAUD",
        "first_name": "KERVIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN26380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mi Doctor LLC
• Michael Eric Tom DC, P.a.
• Michael Physical Therapy
• Sandy Michael, MA
• Hannah Levaine Michaelis, BA, SLP-A
• Tabitha Alain Michaud, MD
• Michelle Rene Condry
• Victoria Tirado Michiel, PA-C
• Mid Florida Counseling, LLC
• Mid Florida Dental

• Orthodontics and Dentofacial Orthopedics Dentistry in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.