Basic Information
| Provider Information | |||||||||
| NPI: | 1376648634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESHAIES | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 587 | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060670587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602583480 | ||||||||
| FaxNumber: | 8605716800 | ||||||||
| Practice Location | |||||||||
| Address1: | 704 HEBRON AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060335020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606591379 | ||||||||
| FaxNumber: | 8606594648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 038635 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.