Healthcare Provider Details

I. General information

NPI: 1114127628
Provider Name (Legal Business Name): MICHEAL K. JUDICE M.D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

4630 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6949
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-2322
  • Fax: 337-981-0183
Mailing address:
  • Phone: 337-989-2322
  • Fax: 337-981-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL KEITH JUDICE I
Title or Position: OWNER
Credential: M.D.
Phone: 337-989-2322