Provider Demographics
NPI:1245263094
Name:VALDES, MICHAEL ANGELO (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANGELO
Last Name:VALDES
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 1:4508 BURKE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2814
Mailing Address - Country:US
Mailing Address - Phone:504-931-5749
Mailing Address - Fax:504-602-9505
Practice Address - Street 1:4320 HOUMA BLVD
Practice Address - Street 2:SUITE 720
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2961
Practice Address - Country:US
Practice Address - Phone:504-835-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200837207Q00000X
FLME119536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508080Medicaid
LA4K182Medicare PIN