Healthcare Provider Details

I. General information

NPI: 1134116189
Provider Name (Legal Business Name): ANDREW J MINARDI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CHERRY ST
MAMOU LA
70554-2223
US

IV. Provider business mailing address

809 CHERRY ST
MAMOU LA
70554-2223
US

V. Phone/Fax

Practice location:
  • Phone: 337-468-5399
  • Fax: 888-317-2910
Mailing address:
  • Phone: 337-468-5399
  • Fax: 888-317-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number022318
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: