Provider Demographics
NPI:1588869309
Name:STUTES, MICHELLE R (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:STUTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 AMB CAFFERY PKWY STE 408
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6950
Mailing Address - Country:US
Mailing Address - Phone:337-534-0018
Mailing Address - Fax:337-889-3805
Practice Address - Street 1:4630 AMB CAFFERY PKWY STE 408
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6950
Practice Address - Country:US
Practice Address - Phone:337-534-0018
Practice Address - Fax:337-889-3805
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026432207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1065889Medicaid
LA1065889Medicaid