Healthcare Provider Details

I. General information

NPI: 1952525719
Provider Name (Legal Business Name): ST TAMMANY CARDIOVASCULAR SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 HIGHWAY 22
MANDEVILLE LA
70471-3310
US

IV. Provider business mailing address

DEPT 165016 P O BOX 62600
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 985-792-7325
  • Fax: 985-792-7327
Mailing address:
  • Phone: 985-792-7325
  • Fax: 985-792-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAVEED MALIK
Title or Position: MANAGER
Credential: MD
Phone: 985-778-5754