Provider Demographics
NPI:1073776431
Name:CHAMBERS, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:CHAMBERS
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 1:8200 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2607
Mailing Address - Country:US
Mailing Address - Phone:504-398-1100
Mailing Address - Fax:504-398-1030
Practice Address - Street 1:8200 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2607
Practice Address - Country:US
Practice Address - Phone:504-398-1100
Practice Address - Fax:504-398-1030
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025901208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441392Medicaid
LA1572292Medicaid
LA1572292Medicaid
LA4P684Medicare PIN
LA5C846Medicare PIN