Healthcare Provider Details

I. General information

NPI: 1659517670
Provider Name (Legal Business Name): PRADEEP KRISHNAN NAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 DUNN ST
HOUMA LA
70360-4413
US

IV. Provider business mailing address

PO BOX 4176
HOUMA LA
70361-4176
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-0300
  • Fax: 985-872-0317
Mailing address:
  • Phone: 985-876-0300
  • Fax: 985-872-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD432572
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number207595
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: