MEDICARE: CANAL STREET CARDIOLOGY

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
1	174400000X	Specialist

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	:	1881640795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANAL STREET CARDIOLOGY

Provider Business Mailing Address
First Line	:	2820 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6302
Country	:	US
Telephone Number	:	504-273-6137
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6302
Country	:	US
Telephone Number	:	504-273-6137
Fax Number	:	504-304-1927

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. GLENN MICHAEL JOHNSON
Credential	:	MD
Telephone Number	:	504-273-6137

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/22/2020

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Directions to “CANAL STREET CARDIOLOGY ” Practice Location

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