Healthcare Provider Details

I. General information

NPI: 1891216503
Provider Name (Legal Business Name): MICHELLE SLIVA MD, MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 100
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

PO BOX 3087
HAMMOND LA
70404-3087
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2663
  • Fax: 985-230-2665
Mailing address:
  • Phone: 859-230-3668
  • Fax: 985-370-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number332584
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number332584
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: