Provider Demographics
NPI:1407819030
Name:BIENVENU, LOUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:BIENVENU
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 1:9808 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-224-8121
Mailing Address - Fax:225-442-1927
Practice Address - Street 1:9808 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-224-8121
Practice Address - Fax:225-442-1927
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103653207P00000X
WI44191207P00000X
LA040391207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP0080713OtherMEDICARE RAILROAD
WI34315400Medicaid
WI930126907OtherMEDICARE RAILROAD
WI930126908OtherMEDICARE RAILROAD
WI005607660Medicare ID - Type Unspecified
WI930126907OtherMEDICARE RAILROAD
B65426Medicare UPIN
WI002117130Medicare ID - Type Unspecified
LA4Q082Medicare PIN