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General NPI Number Information
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NPI Number | 1932320983
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Entity Type | Individual
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Provider Name | MICHELE KAUTZMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 441 WALL BLVD
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City | GRETNA
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State | LA
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Zip | 70056-7723
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Country | US
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Telephone | 504-361-9800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3146
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City | GRETNA
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State | LA
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Zip | 70054-3146
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.205176
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2007-00351
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | MD205176
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.205176
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License Number State | LA
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