Provider Demographics
NPI:1114127628
Name:MICHEAL K. JUDICE M.D., LTD
Entity Type:Organization
Organization Name:MICHEAL K. JUDICE M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JUDICE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:337-989-2322
Mailing Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6949
Mailing Address - Country:US
Mailing Address - Phone:337-989-2322
Mailing Address - Fax:337-981-0183
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-989-2322
Practice Address - Fax:337-981-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940437Medicaid