Provider Demographics
NPI:1629073457
Name:DIBBS, MICHAEL ZIAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ZIAD
Last Name:DIBBS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:121 RUE LOUIS XIV BLDG 4
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5738
Mailing Address - Country:US
Mailing Address - Phone:337-984-9355
Mailing Address - Fax:337-984-9592
Practice Address - Street 1:121 RUE LOUIS XIV BLDG 4
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5738
Practice Address - Country:US
Practice Address - Phone:337-984-9355
Practice Address - Fax:337-984-9592
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2019-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA14398R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1152749Medicaid
LAP00061688Medicare PIN
LA4F090Medicare PIN
LAH54655Medicare UPIN
LA1152749Medicaid