Individual
MICHAEL JESSE MCNULTY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 HOUMA BOULEVARD, SUITE 200, METAIRIE, LA 70006
(504) 897-6351
(504) 899-7317
Mailing address
2731 NAPOLEON AVENUE, NEW ORLEANS, LA 70115
(504) 897-6351
(504) 899-7317
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
MD203982
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP2-0017768
INSTITUTIONAL PERMIT
—
Enumeration date
06/09/2007
Last updated
09/25/2012
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