Provider Demographics
NPI:1760504120
Name:MICHELLE M. DAVIS, LLC
Entity Type:Organization
Organization Name:MICHELLE M. DAVIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MIREILLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-712-7000
Mailing Address - Street 1:200 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-712-7000
Mailing Address - Fax:504-712-7040
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-712-7000
Practice Address - Fax:504-712-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14461R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP97Medicare ID - Type UnspecifiedGROUP NUMBER