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Dr. Michael Wayne Roppolo

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NPI Number Detailed Information

Provider Information:

Name: Dr. Michael Wayne Roppolo
Gender: M
Provider License Number If Given: 20172

NPI Information:

NPI: 1639172687
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 1/7/2013

Provider Business Mailing Address:

Address: PO BOX 83130
Baton Rouge, LA 70884
Phone Number: 2257674893
Fax Number: 2257675494

Provider Business Practice Location Address:

Address: 5131 ODONOVAN DR FL 1
Baton Rouge, LA 70808
Phone Number: 2257674893
Fax Number: 2257675494

Provider Taxonomy:

Primary: 207RN0300X
Secondary (if any):
State: LA

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