Provider Demographics
NPI:1588625487
Name:BURNELL, MICHAEL LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:BURNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:138 LAZARO BLVD SUITE A
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-447-4025
Mailing Address - Fax:337-942-5517
Practice Address - Street 1:138 LAZARO BLVD SUITE A
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-948-1802
Practice Address - Fax:337-942-9074
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2018-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA023031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1493911Medicaid
LA54617Medicare ID - Type Unspecified
LA1493911Medicaid