Healthcare Provider Details

I. General information

NPI: 1699778118
Provider Name (Legal Business Name): MUSTAFA HATIPOGLU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 PARIS RD
CHALMETTE LA
70043-1362
US

IV. Provider business mailing address

4424 CONLIN ST STE 2B
METAIRIE LA
70006-2147
US

V. Phone/Fax

Practice location:
  • Phone: 504-277-8423
  • Fax: 504-888-8730
Mailing address:
  • Phone: 504-888-8717
  • Fax: 504-888-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number03798R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: