Provider Demographics
NPI:1023277530
Name:STUMPF, MICHAEL WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:STUMPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-1712
Mailing Address - Country:US
Mailing Address - Phone:225-358-4853
Mailing Address - Fax:225-358-2282
Practice Address - Street 1:5439 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-1712
Practice Address - Country:US
Practice Address - Phone:225-358-4853
Practice Address - Fax:225-358-2282
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1103314Medicaid
LA4Q228Medicare PIN