Provider Demographics
NPI:1053358051
Name:DUFF, MICHAEL CAMERON (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CAMERON
Last Name:DUFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 MINOT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4052
Mailing Address - Country:US
Mailing Address - Phone:207-783-3393
Mailing Address - Fax:207-783-0848
Practice Address - Street 1:637 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4052
Practice Address - Country:US
Practice Address - Phone:207-783-3393
Practice Address - Fax:207-783-0848
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027949OtherANTHEM BCBS
MEMM9148Medicare PIN