Provider Demographics
NPI:1053465005
Name:LIFSEY, MICHAEL LESTER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LESTER
Last Name:LIFSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4770 S I 10 SERVICE RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1224
Mailing Address - Country:US
Mailing Address - Phone:504-454-3277
Mailing Address - Fax:504-887-8934
Practice Address - Street 1:4770 S I 10 SERVICE RD W STE 110
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-454-3277
Practice Address - Fax:504-887-8934
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA015167207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1341673Medicaid
D04131Medicare UPIN
LA5L749Medicare PIN