Provider Demographics
NPI:1780781872
Name:DEPUY, MIGUEL A (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:DEPUY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8258
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:600 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5727
Practice Address - Country:US
Practice Address - Phone:337-436-3813
Practice Address - Fax:337-439-0214
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA014379207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1393606Medicaid
LA55809CA56Medicare PIN
LA060018480Medicare PIN
LA060067083Medicare PIN
D87520Medicare UPIN
LA55809D048Medicare PIN
LA261635YH5NMedicare PIN