Provider Demographics
NPI:1922005768
Name:LIRTZMAN, MITCHELL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DAVID
Last Name:LIRTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:2730 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5904
Practice Address - Country:US
Practice Address - Phone:337-988-1585
Practice Address - Fax:337-981-9624
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05615R208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1672262Medicaid
LA780000943OtherRR MEDICARE
LA1672262Medicaid
LA5W561DG77Medicare PIN