Provider Demographics
NPI:1588676506
Name:SCREPETIS, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SCREPETIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 4TH ST
Mailing Address - Street 2:BOX 30124
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8423
Mailing Address - Country:US
Mailing Address - Phone:318-445-9823
Mailing Address - Fax:318-769-7348
Practice Address - Street 1:301 4TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8423
Practice Address - Country:US
Practice Address - Phone:318-445-9823
Practice Address - Fax:318-769-7348
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA018528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1918202Medicaid
1960073OtherCIGNA
080029723OtherRAILROAD MEDICARE
01-00312OtherUNITEDHEALTHCARE
E14415Medicare UPIN
5N639Medicare PIN