Healthcare Provider Details

I. General information

NPI: 1043959216
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CONSTANTIN BLVD STE 200
BATON ROUGE LA
70809-3481
US

IV. Provider business mailing address

2137A QUAIL RUN STE B
BATON ROUGE LA
70808-4127
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-9292
  • Fax:
Mailing address:
  • Phone: 225-766-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S CRAPANZANO
Title or Position: OWNER
Credential: MD
Phone: 225-766-9292