Provider Demographics
NPI:1245341338
Name:MOUNIR, MIKE (MD)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:MOUNIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOUNIR
Other - Middle Name:
Other - Last Name:MNAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:443 HEYMANN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2632
Practice Address - Country:US
Practice Address - Phone:337-289-8429
Practice Address - Fax:337-289-8431
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD03758R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1163376Medicaid
B60937Medicare UPIN
LA5K5646833Medicare PIN
LA5K564Medicare ID - Type Unspecified