Provider Demographics
NPI:1942384334
Name:MICHAEL, NICOLE V (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:V
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 POINCIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2243
Mailing Address - Country:US
Mailing Address - Phone:337-468-5261
Mailing Address - Fax:337-468-3342
Practice Address - Street 1:151 HILL ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5845
Practice Address - Country:US
Practice Address - Phone:337-457-7798
Practice Address - Fax:337-550-8020
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9866R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1973041Medicaid
E86757Medicare UPIN
B61677Medicare ID - Type Unspecified