Provider Demographics
NPI:1548204597
Name:MCCORMICK, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 PALMETTO RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6415
Mailing Address - Country:US
Mailing Address - Phone:318-728-2970
Mailing Address - Fax:318-729-7111
Practice Address - Street 1:86 PALMETTO RD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-6415
Practice Address - Country:US
Practice Address - Phone:318-728-2970
Practice Address - Fax:318-728-7111
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12771R207Q00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1555380Medicaid
LA1555380Medicaid
LAG57995Medicare UPIN