Provider Demographics
NPI:1669471074
Name:BRUMUND, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:BRUMUND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 HENRY CLAY AVENUE
Mailing Address - Street 2:CHILDREN'S HOSPITAL
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-896-2723
Mailing Address - Fax:504-896-2720
Practice Address - Street 1:200 HENRY CLAY AVENUE
Practice Address - Street 2:CHILDREN'S HOSPITAL
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-9751
Practice Address - Fax:504-896-3952
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA13782R2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1436470Medicaid
LA4A065Medicare ID - Type Unspecified
LA1436470Medicaid