Healthcare Provider Details

I. General information

NPI: 1144279134
Provider Name (Legal Business Name): NORTHLAKE PULMONARY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 S TYLER ST SUITE 200
COVINGTON LA
70433-2353
US

IV. Provider business mailing address

1203 S TYLER ST SUITE 200
COVINGTON LA
70433-2353
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-9143
  • Fax: 985-892-9656
Mailing address:
  • Phone: 985-892-9143
  • Fax: 985-892-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD A KUEBEL
Title or Position: OWNER
Credential: M.D.
Phone: 985-892-9143