Provider Demographics
NPI:1154345544
Name:ALVAREZ, MICHAEL LUIS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LUIS
Last Name:ALVAREZ
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 1:520 N LEWIS ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2094
Mailing Address - Country:US
Mailing Address - Phone:337-364-0408
Mailing Address - Fax:337-364-7337
Practice Address - Street 1:501 W SAINT MARY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4665
Practice Address - Country:US
Practice Address - Phone:337-470-4500
Practice Address - Fax:337-470-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA15622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1346705Medicaid
LA5L735Medicare ID - Type Unspecified
LA1346705Medicaid