Healthcare Provider Details

I. General information

NPI: 1780633248
Provider Name (Legal Business Name): MICHAEL KIERNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S. I-10 SERVICE RD. WEST STE 101
METAIRIE LA
70001
US

IV. Provider business mailing address

1430 TULANE AVE SL-37
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-780-4436
  • Fax: 504-780-4439
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD2014-0984
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number65827-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD.06458R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: