Provider Demographics
NPI:1447290531
Name:BEARD, MICHEL MARTIN (LOTR, CHT)
Entity type:Individual
Prefix:MRS
First Name:MICHEL
Middle Name:MARTIN
Last Name:BEARD
Suffix:
Gender:F
Credentials:LOTR, CHT
Other - Prefix:MS
Other - First Name:MICHEL
Other - Middle Name:ALLAIN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5232 BIGMAN LN
Mailing Address - Street 2:
Mailing Address - City:OSCAR
Mailing Address - State:LA
Mailing Address - Zip Code:70762-6211
Mailing Address - Country:US
Mailing Address - Phone:225-627-7642
Mailing Address - Fax:
Practice Address - Street 1:1219 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2347
Practice Address - Country:US
Practice Address - Phone:225-658-7751
Practice Address - Fax:225-658-7753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B344Medicare ID - Type Unspecified