Provider Demographics
NPI:1871816488
Name:DUQUE, MICHAEL SISON (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SISON
Last Name:DUQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:674 AQUIDNECK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5795
Mailing Address - Country:US
Mailing Address - Phone:401-847-9955
Mailing Address - Fax:401-847-9948
Practice Address - Street 1:674 AQUIDNECK AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5795
Practice Address - Country:US
Practice Address - Phone:401-847-9955
Practice Address - Fax:401-847-9948
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIMD14004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program