MEDICARE: NORTHLAKE PULMONARY ASSOCIATES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	LA
3	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144279134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAKE PULMONARY ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	1203 S TYLER ST
Second Line	:	SUITE 200
City	:	COVINGTON
State	:	LA
Zip	:	70433-2353
Country	:	US
Telephone Number	:	985-892-9143
Fax Number	:	985-892-9656

Provider Business Practice Location Address
First Line	:	1203 S TYLER ST
Second Line	:	SUITE 200
City	:	COVINGTON
State	:	LA
Zip	:	70433-2353
Country	:	US
Telephone Number	:	985-892-9143
Fax Number	:	985-892-9656

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONALD A KUEBEL
Credential	:	M.D.
Telephone Number	:	985-892-9143

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/13/2013

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Directions to “NORTHLAKE PULMONARY ASSOCIATES INC. ” Practice Location

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