Healthcare Provider Details

I. General information

NPI: 1013361187
Provider Name (Legal Business Name): STIEL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY STE 412
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

4630 AMBASSADOR CAFFERY PKWY STE 412
LAFAYETTE LA
70508-6949
US

V. Phone/Fax

Practice location:
  • Phone: 337-993-3933
  • Fax:
Mailing address:
  • Phone: 337-993-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD.207283
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License NumberMD.207283
License Number StateLA

VIII. Authorized Official

Name: ABIGAIL HART
Title or Position: OWNER
Credential: MD
Phone: 504-858-6386