Provider Demographics
NPI:1255339545
Name:FAJONI, MICHAEL L (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:FAJONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2988
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2988
Mailing Address - Country:US
Mailing Address - Phone:985-345-0050
Mailing Address - Fax:985-345-5800
Practice Address - Street 1:1615 SW RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6113
Practice Address - Country:US
Practice Address - Phone:985-345-0050
Practice Address - Fax:985-345-5800
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2015-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA10542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA180006364OtherRAILROAD MEDICARE
LA1105813Medicaid
LA1105813Medicaid
LA180006364OtherRAILROAD MEDICARE