Healthcare Provider Details

I. General information

NPI: 1992765440
Provider Name (Legal Business Name): MICHAEL LANGIULLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRAMMONT ST SUITE 303
MONROE LA
71201-7457
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 318-966-8850
  • Fax: 318-966-8851
Mailing address:
  • Phone: 225-526-0011
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.203554
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number203554
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number203554
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: