# MICHAEL BOURQUE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1518939321
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 029964 | CT | — |
| 2086S0120X | Pediatric Surgery Physician | 029964 | CT | Yes |

## Other

- **Enumeration date:** 02/06/2006
- **Last updated:** 11/04/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001299644 | — | CT |