Provider Demographics
NPI:1922269281
Name:BIENVENU, MELANIE MONTGOMERY (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MONTGOMERY
Last Name:BIENVENU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 W. CONGRESS ST.
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-261-6759
Mailing Address - Fax:337-261-6795
Practice Address - Street 1:2390 W. CONGRESS ST.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-261-6759
Practice Address - Fax:337-261-6795
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33915207RG0100X
LA206954207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2371118Medicaid
LA366718YKF1Medicare PIN