Individual
MICHAEL TODD FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8595 PICARDY AVE, STE 305, BATON ROUGE, LA 70809-3670
(225) 763-4438
(225) 763-4490
Mailing address
8490 PICARDY AVE, BLDG 200, BATON ROUGE, LA 70809-3731
(225) 237-1754
(225) 237-1722
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0088212
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2162900
—
LA
01
—
4Q548DH48
MEDICARE PTAN
LA
Enumeration date
07/19/2005
Last updated
09/23/2014
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