Healthcare Provider Details

I. General information

NPI: 1174027973
Provider Name (Legal Business Name): MICHELLE ANITA BERGERON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 337-470-4765
  • Fax: 337-470-2809
Mailing address:
  • Phone: 337-470-4765
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License Number343316
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: