Healthcare Provider Details

I. General information

NPI: 1922493030
Provider Name (Legal Business Name): IMRAN SHUJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CHEROKEE ROSE LN
COVINGTON LA
70433-7201
US

IV. Provider business mailing address

217 CHEROKEE ROSE LN
COVINGTON LA
70433-7201
US

V. Phone/Fax

Practice location:
  • Phone: 858-930-9119
  • Fax: 985-875-7565
Mailing address:
  • Phone: 985-893-0911
  • Fax: 985-875-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10398500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number309966
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number309966
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: