Provider Demographics
NPI:1588741359
Name:PATNAUDE, MICHAEL R (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:PATNAUDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3176
Mailing Address - Country:US
Mailing Address - Phone:207-775-7171
Mailing Address - Fax:207-775-7117
Practice Address - Street 1:50 PARK RD STE 2
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3176
Practice Address - Country:US
Practice Address - Phone:207-775-7171
Practice Address - Fax:207-775-7117
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1557192084P0800X
ME15682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME224941000OtherMAGELLAN
ME2011304OtherCIGNA
ME135500000Medicaid
ME224941000OtherMAGELLAN
ME2011304OtherCIGNA