Healthcare Provider Details

I. General information

NPI: 1205878006
Provider Name (Legal Business Name): MICHELE M ZEMBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

1430 TULANE AVE # SL-32
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9569
  • Fax: 504-896-9849
Mailing address:
  • Phone: 504-988-2178
  • Fax: 504-988-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number07136R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: