Healthcare Provider Details

I. General information

NPI: 1497785372
Provider Name (Legal Business Name): FIROOZ JALILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD STE 203
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

PO BOX 52545
LAFAYETTE LA
70505-2545
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-2535
  • Fax: 337-235-0157
Mailing address:
  • Phone: 337-233-2535
  • Fax: 337-235-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05553R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number05553R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: