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NPI Code Detail

MEDICARE: MR. HUSAM HAIDAR SUKEREK M.D.

MEDICARE: MR. HUSAM HAIDAR SUKEREK M.D.
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
1208000000XPediatrics Physician13676RLA
22080P0206XPediatric Gastroenterology Physician13676RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113676ROTHERLAMEDICAL LISCENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699778597
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HUSAM HAIDAR SUKEREK M.D.
Provider Business Mailing Address
First Line : 210 HIGHLAND DR
Second Line :
City : MANY
State : LA
Zip : 71449-3718
Country : US
Telephone Number : 318-256-5722
Fax Number : 318-256-5774
Provider Business Practice Location Address
First Line : 210 HIGHLAND DR
Second Line :
City : MANY
State : LA
Zip : 71449-3718
Country : US
Telephone Number : 318-256-5722
Fax Number : 318-256-5774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 03/07/2023

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