MEDICARE: DR. MICHELE CAMPISI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	200578	LA
2	207P00000X	Emergency Medicine Physician	C1-0006080	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194763862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE CAMPISI MD

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:	SUITE 201
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 W ESPLANADE AVE
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70065-2467
Country	:	US
Telephone Number	:	302-227-8508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/22/2008

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