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NPI Code Detail

MEDICARE: LOUISIANA MUA, LLC

MEDICARE: LOUISIANA MUA, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) Physician12502RLA

General Provider Information

NPI Number : 1235428806
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUISIANA MUA, LLC
Provider Business Mailing Address
First Line : 851 MEADOWS RD
Second Line : SUITE 213
City : BOCA RATON
State : FL
Zip : 33486-2348
Country : US
Telephone Number : 561-392-1333
Fax Number : 561-392-9707
Provider Business Practice Location Address
First Line : 9118 BLUEBONNET CENTRE BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-2993
Country : US
Telephone Number : 225-368-2300
Fax Number :
Authorized Official
Title or Position : PRES
Name : BRUCE MICHAEL FISCHER
Credential : DC
Telephone Number : 561-392-1333
Provider Enumeration Date : 04/04/2011
Last Update Date : 04/04/2011

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Directions to “LOUISIANA MUA, LLC ” Practice Location

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