Healthcare Provider Details

I. General information

NPI: 1417167750
Provider Name (Legal Business Name): MARKUS VATTAKATTIL JOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARK VATTAKATTIL JOHN M.D.

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 WE HECK CT BUILDING M-1
BATON ROUGE LA
70816-0416
US

IV. Provider business mailing address

4021 WE HECK CT BUILDING M-1
BATON ROUGE LA
70816-0416
US

V. Phone/Fax

Practice location:
  • Phone: 225-263-0600
  • Fax: 225-263-0601
Mailing address:
  • Phone: 225-263-0600
  • Fax: 225-263-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD202152
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: