Healthcare Provider Details

I. General information

NPI: 1316005853
Provider Name (Legal Business Name): INDIRA MOHAN KAILAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 WESTBANK EXPRESSWAY
MARRERO LA
70072
US

IV. Provider business mailing address

3300 WEST ESPLANADE AVE SUITE 213
METAIRIE LA
70002
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-8708
  • Fax: 504-838-5714
Mailing address:
  • Phone: 504-838-5312
  • Fax: 504-838-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberR#005403, L#017047
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR#005403, L#017047
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: