Healthcare Provider Details

I. General information

NPI: 1538171327
Provider Name (Legal Business Name): PEDIATRIC INTENSIVISTS OF LA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD SUITE 103
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

7777 HENNESSY BLVD SUITE 103
BATON ROUGE LA
70808-4300
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-6700
  • Fax: 225-767-6721
Mailing address:
  • Phone: 225-767-6700
  • Fax: 225-767-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SANDERS CRAPANZANO
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 225-767-6700