Provider Demographics
NPI:1124108436
Name:MICHELLE M ANDRE, MD, LLC
Entity type:Organization
Organization Name:MICHELLE M ANDRE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-851-1001
Mailing Address - Street 1:1007 BELANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4411
Mailing Address - Country:US
Mailing Address - Phone:985-851-1001
Mailing Address - Fax:985-851-1071
Practice Address - Street 1:1007 BELANGER ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-851-1001
Practice Address - Fax:985-851-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449172Medicaid
LA1449172Medicaid
LA5Y017Medicare ID - Type Unspecified