Provider Demographics
NPI:1841210127
Name:MARISTANY, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MARISTANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2020 GRAVIER ST
Mailing Address - Street 2:ROOM 759
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2272
Mailing Address - Country:US
Mailing Address - Phone:504-903-3087
Mailing Address - Fax:504-568-4633
Practice Address - Street 1:1532 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2860
Practice Address - Country:US
Practice Address - Phone:504-903-3087
Practice Address - Fax:504-568-4633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA0252872085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA025287OtherMEDICAL LICENSE
LA29038OtherSTATE CDS
LA29038OtherSTATE CDS