Individual
MICHAEL CHRISTOPHER BOUCREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Mailing address
2500 BELLE CHASSE HWY, TERRYTOWN, LA 70056-7127
(504) 391-5046
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301052096
MI
208M00000X
Hospitalist Physician
Primary
MD.017904
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04955201
—
MS
01
—
0B56031
BLUE SHIELD
MI
05
—
2169866
—
LA
05
—
3309801
—
MI
Enumeration date
12/08/2006
Last updated
01/05/2012
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