Provider Demographics
NPI:1215087887
Name:PREJEAN, MICHAEL J (MD PSYCHIATRIST)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:PREJEAN
Suffix:
Gender:M
Credentials:MD PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12698
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315
Mailing Address - Country:US
Mailing Address - Phone:318-627-6280
Mailing Address - Fax:318-627-6280
Practice Address - Street 1:1610 7TH ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554
Practice Address - Country:US
Practice Address - Phone:337-468-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA117032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1133931Medicaid
LA54681Medicare ID - Type Unspecified
B65378Medicare UPIN