Provider Demographics
NPI:1629378369
Name:R.R. MICHEL, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:R.R. MICHEL, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:R
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-253-6017
Mailing Address - Street 1:110 LARUE MEDECINE
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2637
Mailing Address - Country:US
Mailing Address - Phone:318-253-6017
Mailing Address - Fax:318-253-8256
Practice Address - Street 1:110 LARUE MEDECINE
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2637
Practice Address - Country:US
Practice Address - Phone:318-253-6017
Practice Address - Fax:318-253-8256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.R. MICHEL, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB64657Medicare UPIN