Provider Demographics
NPI:1750382784
Name:TARANTINO, MICHAEL JUDE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDE
Last Name:TARANTINO
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 1:108 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2822
Mailing Address - Country:US
Mailing Address - Phone:337-365-5881
Mailing Address - Fax:
Practice Address - Street 1:108 ARBOR LN
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2822
Practice Address - Country:US
Practice Address - Phone:337-365-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010736208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136042Medicaid
LA55364Medicare PIN
B65721Medicare UPIN