Healthcare Provider Details

I. General information

NPI: 1053311530
Provider Name (Legal Business Name): JOHN F NITSCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD SUITE 600B
METAIRIE LA
70006-2933
US

IV. Provider business mailing address

155 ELM ST
MANDEVILLE LA
70448-4575
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-2191
  • Fax: 504-378-1838
Mailing address:
  • Phone: 985-626-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number014479
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: