Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD200023 | LA |
NPI | 1053504662 |
---|---|
Provider Name | Dr. Michelle A Chico |
First Address | Nashville, TN 37241-5000 |
Second Address | Shreveport, LA 71105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1040983 | (05) | LA |
P00814512 | RR MEDICARE NUMBER (01) | LA |