Healthcare Provider Details

I. General information

NPI: 1669464400
Provider Name (Legal Business Name): MALIKA MORSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE SUITE 103
KENNER LA
70065-2489
US

IV. Provider business mailing address

200 W. ESPLANADE AVE. SUITE 103
KENNER LA
70065-2473
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-8712
  • Fax: 504-464-8711
Mailing address:
  • Phone: 504-464-8712
  • Fax: 504-464-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number15073R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: