Healthcare Provider Details

I. General information

NPI: 1386626356
Provider Name (Legal Business Name): PEDIATRICS KID-MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MEADOWCREST ST SUITE 245
GRETNA LA
70056-5255
US

IV. Provider business mailing address

120 MEADOWCREST ST SUITE 245
GRETNA LA
70056-5255
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-7690
  • Fax: 504-391-7625
Mailing address:
  • Phone: 504-391-7690
  • Fax: 504-391-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. HARISH C. ANAND
Title or Position: OWNER
Credential: M.D.
Phone: 504-391-7690