1295938892 NPI number — MICHAEL JESSE MCNULTY IV MD

Table of content: MICHAEL JESSE MCNULTY IV MD (NPI 1295938892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295938892 NPI number — MICHAEL JESSE MCNULTY IV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNULTY
Provider First Name:
MICHAEL
Provider Middle Name:
JESSE
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295938892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2731 NAPOLEON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-897-6351
Provider Business Mailing Address Fax Number:
504-899-7317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 HOUMA BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-897-6351
Provider Business Practice Location Address Fax Number:
504-899-7317
Provider Enumeration Date:
06/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  MD203982 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BP2-0017768 . This is a "INSTITUTIONAL PERMIT" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com