Provider Demographics
NPI:1750691341
Name:MICHAEL W DUPRE, M.D., LLC
Entity type:Organization
Organization Name:MICHAEL W DUPRE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-755-3070
Mailing Address - Street 1:P.O. BOX 85168
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0000
Mailing Address - Country:US
Mailing Address - Phone:225-819-1186
Mailing Address - Fax:225-819-1139
Practice Address - Street 1:8595 PICARDY AVENUE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3670
Practice Address - Country:US
Practice Address - Phone:225-819-1186
Practice Address - Fax:225-819-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022121305R00000X
LAMD.022121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1661767Medicaid
LA1661767Medicaid
LA5W205Medicare PIN