Healthcare Provider Details

I. General information

NPI: 1194729079
Provider Name (Legal Business Name): CARDIOLOGY CENTER OF ACADIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 RUE LOUIS XIV BLDG 4 SUITE B
LAFAYETTE LA
70508-5738
US

IV. Provider business mailing address

121 RUE LOUIS XIV BLDG 4 SUITE B
LAFAYETTE LA
70508-5738
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-9355
  • Fax: 337-984-9592
Mailing address:
  • Phone: 337-984-9355
  • Fax: 337-984-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14398R
License Number StateLA

VIII. Authorized Official

Name: DR. MICHAEL ZIAD DIBBS
Title or Position: OWNER
Credential: M.D.
Phone: 337-984-9355