Individual
LANE MIKAEL FREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
726 N ACADIA RD., STE 3300, THIBODAUX, LA 70301
(985) 493-3080
(985) 493-3081
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 493-4578
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD.205457
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1894192
—
LA
Enumeration date
06/26/2009
Last updated
07/05/2018
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