Individual
DR. MICHAEL LOUIS BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2770 3RD AVE STE 210, LAKE CHARLES, LA 70601-0404
(337) 494-6768
(337) 494-6792
Mailing address
PO BOX 122579 DEPT 2579, DALLAS, TX 75312-2579
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD025609
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043281
—
LA
Enumeration date
03/20/2007
Last updated
05/12/2022
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