Healthcare Provider Details

I. General information

NPI: 1942384334
Provider Name (Legal Business Name): NICOLE V MICHAEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 HILL ST
EUNICE LA
70535-5845
US

IV. Provider business mailing address

801 POINCIANA AVE
MAMOU LA
70554-2243
US

V. Phone/Fax

Practice location:
  • Phone: 337-457-7798
  • Fax: 337-550-8020
Mailing address:
  • Phone: 337-468-5261
  • Fax: 337-468-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9866R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: