Provider Demographics
NPI:1023300332
Name:SICARD, COLLEEN C (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:C
Last Name:SICARD
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 1:200 BEAULLIEU DR STE 7
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7230
Mailing Address - Country:US
Mailing Address - Phone:337-366-8616
Mailing Address - Fax:337-366-8133
Practice Address - Street 1:200 BEAULLIEU DR STE 7
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-366-8616
Practice Address - Fax:337-366-8133
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207266208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2144588Medicaid