MEDICARE: MICHAEL TODD FONTENOT 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	174400000X	Specialist	ME0088212	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4Q548DH48	OTHER	LA	MEDICARE PTAN

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

General Provider Information

NPI Number	:	1982603254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TODD FONTENOT M.D.

Provider Business Mailing Address
First Line	:	8490 PICARDY AVE
Second Line	:	BLDG 200
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3731
Country	:	US
Telephone Number	:	225-237-1754
Fax Number	:	225-237-1722

Provider Business Practice Location Address
First Line	:	8595 PICARDY AVE
Second Line	:	STE 305
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3670
Country	:	US
Telephone Number	:	225-763-4438
Fax Number	:	225-763-4490

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/23/2014

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