Healthcare Provider Details

I. General information

NPI: 1114051653
Provider Name (Legal Business Name): NORTHSTAR NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VEROT SCHOOL RD
LAFAYETTE LA
70508-5026
US

IV. Provider business mailing address

PO BOX 81082
LAFAYETTE LA
70598-1082
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-3850
  • Fax:
Mailing address:
  • Phone: 337-233-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEOPOLDO DEALVARE
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 337-233-3850