Healthcare Provider Details

I. General information

NPI: 1013344027
Provider Name (Legal Business Name): LAKEVIEW CARDIOLOGY SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JUDGE TANNER BLVD SUITE 106
COVINGTON LA
70433-7503
US

IV. Provider business mailing address

PO BOX 742845
ATLANTA GA
30374-2845
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-8959
  • Fax: 985-892-8975
Mailing address:
  • Phone: 615-373-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN REBOK
Title or Position: GROUP VICE PRESIDENT/AO
Credential:
Phone: 615-372-5004