Healthcare Provider Details

I. General information

NPI: 1730716309
Provider Name (Legal Business Name): MATHOULA BILALIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CHEROKEE ROSE LN
COVINGTON LA
70433-7244
US

IV. Provider business mailing address

1430 TULANE AVE RM 7031
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-1721
  • Fax: 985-871-4049
Mailing address:
  • Phone: 504-988-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number351498
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: