Provider Demographics
NPI:1326138850
Name:MICHEL, KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:MICHEL
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 1:3131 NORTH I 10 SERVICE ROAD EAST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-0000
Mailing Address - Country:US
Mailing Address - Phone:504-833-7770
Mailing Address - Fax:504-833-7796
Practice Address - Street 1:3131 NORTH I 10 SERVICE ROAD EAST
Practice Address - Street 2:SUITE 308
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-0000
Practice Address - Country:US
Practice Address - Phone:504-833-7770
Practice Address - Fax:504-833-7796
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10640R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF92686Medicare UPIN
LA5A853Medicare ID - Type Unspecified
LA1999741Medicare ID - Type Unspecified