Provider Demographics
NPI:1093716169
Name:LEBRUN, MICHEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:J
Last Name:LEBRUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:NORTH 504
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-6705
Mailing Address - Fax:504-347-0813
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:NORTH 504
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6705
Practice Address - Fax:504-347-0813
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA04735R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1195804Medicaid
LA5K277B114Medicare ID - Type Unspecified
LA1195804Medicaid