Healthcare Provider Details

I. General information

NPI: 1891510897
Provider Name (Legal Business Name): HEALR CLINIC OF LAFAYETTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 AMBASSADOR CAFFERY PKWY STE 120C
LAFAYETTE LA
70503-5275
US

IV. Provider business mailing address

3809 AMBASSADOR CAFFERY PKWY STE 120C
LAFAYETTE LA
70503-5275
US

V. Phone/Fax

Practice location:
  • Phone: 337-446-4501
  • Fax: 337-436-2144
Mailing address:
  • Phone: 337-446-4501
  • Fax: 337-436-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KUNTAL MOHARE
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 337-446-4501