Healthcare Provider Details

I. General information

NPI: 1477737914
Provider Name (Legal Business Name): ADIL ARYAMAN FATAKIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BARATARIA BLVD STE 3100
MARRERO LA
70072-3083
US

IV. Provider business mailing address

1151 BARATARIA BLVD STE 3100
MARRERO LA
70072-3083
US

V. Phone/Fax

Practice location:
  • Phone: 504-934-8461
  • Fax: 504-371-3811
Mailing address:
  • Phone: 504-934-8462
  • Fax: 504-371-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberPGY.1.TUL-OTO
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.203370
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: