Healthcare Provider Details

I. General information

NPI: 1417651894
Provider Name (Legal Business Name): MIKE LE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11485 FLORIDA BLVD STE B
BATON ROUGE LA
70815-2404
US

IV. Provider business mailing address

755 SHERWOOD FOREST BLVD
BATON ROUGE LA
70815-5261
US

V. Phone/Fax

Practice location:
  • Phone: 225-485-9440
  • Fax:
Mailing address:
  • Phone: 225-485-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number351679
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: