Provider Demographics
NPI:1215111786
Name:PERREAULT, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:PERREAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-2252
Mailing Address - Fax:
Practice Address - Street 1:9040 A JACKSON AVE
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-CLL
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1101
Practice Address - Country:US
Practice Address - Phone:253-968-1250
Practice Address - Fax:253-968-2550
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND10855207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine