Healthcare Provider Details

I. General information

NPI: 1255339545
Provider Name (Legal Business Name): MICHAEL L FAJONI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SW RAILROAD AVE
HAMMOND LA
70403-6113
US

IV. Provider business mailing address

PO BOX 2988
HAMMOND LA
70404-2988
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-0050
  • Fax: 985-345-5800
Mailing address:
  • Phone: 985-345-0050
  • Fax: 985-345-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number10542
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: