Provider Demographics
NPI:1588835185
Name:BLUE, MICHAEL SINCLAIR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SINCLAIR
Last Name:BLUE
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 1:124 E MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3725
Mailing Address - Country:US
Mailing Address - Phone:337-321-6288
Mailing Address - Fax:504-897-2436
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3725
Practice Address - Country:US
Practice Address - Phone:337-321-6288
Practice Address - Fax:504-897-2436
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2034882084P0800X, 2084F0202X
NY2490912084P0800X
MA2367092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2108531Medicaid