Provider Demographics
NPI:1245439827
Name:MENARD, MICHELLE LEROUGE (MD)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEROUGE
Last Name:MENARD
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 1:2309 EAST MAIN STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560
Mailing Address - Country:US
Mailing Address - Phone:337-367-0271
Mailing Address - Fax:337-364-6139
Practice Address - Street 1:2309 EAST MAIN STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-367-0271
Practice Address - Fax:337-364-6139
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD202746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1006254Medicaid
LA4Q034CN33Medicare PIN