Individual
MICHAEL BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 WOODLAND STREET, SUITE 31, HARTFORD, CT 06105
(860) 728-1212
(860) 724-5224
Mailing address
19 WOODLAND STREET, SUITE 31, HARTFORD, CT 06105
(860) 728-1212
(860) 724-5224
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
020526
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001205269
—
CT
Enumeration date
09/06/2006
Last updated
01/06/2012
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