Provider Demographics
NPI:1164956827
Name:OCCUCARE INTERNATIONAL LAFAYETTE
Entity Type:Organization
Organization Name:OCCUCARE INTERNATIONAL LAFAYETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ODINET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-704-0920
Mailing Address - Street 1:1028 FORUM DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-8060
Mailing Address - Country:US
Mailing Address - Phone:337-704-0891
Mailing Address - Fax:337-704-0924
Practice Address - Street 1:1028 FORUM DR
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-8060
Practice Address - Country:US
Practice Address - Phone:337-704-0891
Practice Address - Fax:337-704-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty