Healthcare Provider Details

I. General information

NPI: 1669675054
Provider Name (Legal Business Name): WILLCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DRURY LN
LAFAYETTE LA
70508-5702
US

IV. Provider business mailing address

100 DRURY LN
LAFAYETTE LA
70508-5702
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-4949
  • Fax: 337-269-4950
Mailing address:
  • Phone: 337-269-4949
  • Fax: 337-269-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number200512
License Number StateLA

VIII. Authorized Official

Name: DR. STEPHEN J DELATTE
Title or Position: OWNER
Credential: M.D.
Phone: 337-269-4949