Healthcare Provider Details

I. General information

NPI: 1053588467
Provider Name (Legal Business Name): CULLEN MICHAEL OCMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 LUTCHER AVE
LUTCHER LA
70071-5150
US

IV. Provider business mailing address

1645 LUTCHER AVE
LUTCHER LA
70071-0000
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-9890
  • Fax: 225-869-3822
Mailing address:
  • Phone: 225-869-9890
  • Fax: 225-869-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number203080
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: