Provider Demographics
NPI:1043282510
Name:DAIGLE, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DAIGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S COLLEGE RD
Mailing Address - Street 2:STE 302
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3038
Mailing Address - Country:US
Mailing Address - Phone:337-233-8843
Mailing Address - Fax:337-233-8844
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:STE 302
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-233-8843
Practice Address - Fax:337-233-8844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1140147Medicaid
LA1140147Medicaid
LA5K836Medicare ID - Type Unspecified