Healthcare Provider Details

I. General information

NPI: 1750321394
Provider Name (Legal Business Name): SUHAIL NASERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52579 HIGHWAY 51 SOUTH LALLIE KEMP HOSPITAL
INDEPENDENCE LA
70443
US

IV. Provider business mailing address

17145 BRIDLE PATH
HAMMOND LA
70403-4781
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-9421
  • Fax: 985-878-1431
Mailing address:
  • Phone: 504-486-5807
  • Fax: 985-878-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number03804R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: