Healthcare Provider Details

I. General information

NPI: 1134180623
Provider Name (Legal Business Name): MICHAEL JOHN ST. PIERRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5253 DIJON DR SUITE A
BATON ROUGE LA
70808-4312
US

IV. Provider business mailing address

5253 DIJON DR SUITE A
BATON ROUGE LA
70808-4312
US

V. Phone/Fax

Practice location:
  • Phone: 225-768-1611
  • Fax: 225-768-1615
Mailing address:
  • Phone: 225-768-1611
  • Fax: 225-768-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12194R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: