Healthcare Provider Details

I. General information

NPI: 1548300866
Provider Name (Legal Business Name): HEART CENTER OF ACADIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY N SUITE 1400
LAFAYETTE LA
70508-6965
US

IV. Provider business mailing address

PO BOX 53628
LAFAYETTE LA
70505-3628
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-9003
  • Fax: 337-988-9921
Mailing address:
  • Phone: 337-291-9410
  • Fax: 337-593-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12136R
License Number StateLA

VIII. Authorized Official

Name: DR. SYED FAZAL-UR-REHMAN
Title or Position: PHYSICIAN
Credential: M.D.,
Phone: 337-291-9410