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Contact Information

MICHAEL S THIBAULT, PAC
25 TAMARACK AVENUE
ADVANCED DERM CARE, PC
DANBURY, CT06811
 Phone: 203-797-8990
 Fax: 203-748-7861
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Dermatology

207N00000X 07 Physician/Dermatology
 

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MICHAEL S THIBAULT · (Male)

NPI Number 1659324515
Status Active
Credentials PAC
Entity Individual
Enumeration date 05/19/2006
Last updated 01/16/2026 - About 5 months ago
Sole proprietor 1 No
Identifiers
  • CO License # PA 1933
  • CT License # 001389
  • CT License # 1389
  • CO Other PA1933 PA LICENSE
Hospital affiliation(s)
  • STAMFORD HOSPITAL - (Acute Care)
    30 SHELBURNE ROAD
    STAMFORD, CT 06904
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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