Healthcare Provider Details

I. General information

NPI: 1841210127
Provider Name (Legal Business Name): MICHAEL L. MARISTANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 TULANE AVE
NEW ORLEANS LA
70112-2860
US

IV. Provider business mailing address

2020 GRAVIER ST ROOM 759
NEW ORLEANS LA
70112-2272
US

V. Phone/Fax

Practice location:
  • Phone: 504-903-3087
  • Fax: 504-568-4633
Mailing address:
  • Phone: 504-903-3087
  • Fax: 504-568-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number025287
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: