Provider Demographics
NPI:1790284016
Name:FUSELIER, ALEX MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MICHAEL
Last Name:FUSELIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-769-7779
Mailing Address - Fax:337-769-7800
Practice Address - Street 1:2308 E MAIN STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-408-8676
Practice Address - Fax:337-408-8680
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2023-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
LA337927208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program