Healthcare Provider Details

I. General information

NPI: 1952812455
Provider Name (Legal Business Name): MARAIST FOOT AND ANKLE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S BEADLE RD # B2
LAFAYETTE LA
70508-4287
US

IV. Provider business mailing address

185 S BEADLE RD # B2
LAFAYETTE LA
70508-4287
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-0384
  • Fax: 337-761-6021
Mailing address:
  • Phone: 337-234-0384
  • Fax: 337-761-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM.200012
License Number StateLA

VIII. Authorized Official

Name: KELLI DUHON
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-280-6298