MEDICARE: MICHELLE R BEURLOT M.D.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	322103	LA
2	390200000X	Student in an Organized Health Care Education/Training Program	BP10041034	TX
3	207Q00000X	Family Medicine Physician	322103	LA

General Provider Information

NPI Number	:	1235484189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE R BEURLOT M.D.

Provider Business Mailing Address
First Line	:	1587 N BOLTON AVE STE 1100
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-4255
Country	:	US
Telephone Number	:	318-445-9823
Fax Number	:	318-445-1509

Provider Business Practice Location Address
First Line	:	1587 N BOLTON AVE STE 1100
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-4255
Country	:	US
Telephone Number	:	318-445-9823
Fax Number	:	318-445-1509

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

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	10/15/2020

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Directions to “ MICHELLE R BEURLOT M.D.” Practice Location

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