Healthcare Provider Details

I. General information

NPI: 1750691341
Provider Name (Legal Business Name): MICHAEL W DUPRE, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 PICARDY AVENUE
BATON ROUGE LA
70809-3670
US

IV. Provider business mailing address

P.O. BOX 85168
BATON ROUGE LA
70816-0000
US

V. Phone/Fax

Practice location:
  • Phone: 225-819-1186
  • Fax: 225-819-1139
Mailing address:
  • Phone: 225-819-1186
  • Fax: 225-819-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD.022121
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number022121
License Number StateLA

VIII. Authorized Official

Name: DR. MICHAEL W DUPRE
Title or Position: DOCTOR
Credential: M.D.
Phone: 225-755-3070