Healthcare Provider Details

I. General information

NPI: 1992977110
Provider Name (Legal Business Name): OBGYN BILLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S I 10 SERVICE RD W STE 104
METAIRIE LA
70001-7403
US

IV. Provider business mailing address

4720 S I 10 SERVICE RD W STE 104
METAIRIE LA
70001-7403
US

V. Phone/Fax

Practice location:
  • Phone: 504-457-0299
  • Fax:
Mailing address:
  • Phone: 504-457-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL018221
License Number StateLA

VIII. Authorized Official

Name: DR. MICHAEL E GRAHAM
Title or Position: OWNER
Credential: MD
Phone: 504-457-0299