Healthcare Provider Details

I. General information

NPI: 1417604448
Provider Name (Legal Business Name): CARLO EMILCAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALTERS ST
LAKE CHARLES LA
70607-4647
US

IV. Provider business mailing address

PO BOX 122108 DEPT 2108
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-3102
  • Fax: 337-480-8109
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number347324
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: