MEDICARE: DR. MICHAEL KEVIN PUYAU 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	208600000X	Surgery Physician	017436	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55136	OTHER	LA	MEDICARE PTAN

General Provider Information

NPI Number	:	1467598102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KEVIN PUYAU M.D.

Provider Business Mailing Address
First Line	:	500 RUE DE LA VIE ST STE 402
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5129
Country	:	US
Telephone Number	:	225-215-7588
Fax Number	:	225-928-8860

Provider Business Practice Location Address
First Line	:	500 RUE DE LA VIE ST STE 402
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5129
Country	:	US
Telephone Number	:	225-924-7588
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	01/18/2019

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