Healthcare Provider Details

I. General information

NPI: 1730180472
Provider Name (Legal Business Name): MICHAEL DEWITT TEAGUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-4050
  • Fax: 225-765-4046
Mailing address:
  • Phone: 225-765-4050
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number022014
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number022014
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: