Healthcare Provider Details

I. General information

NPI: 1316133051
Provider Name (Legal Business Name): DHAYA N. KUTNIKAR M.D. APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 LAMY LN
MONROE LA
71201-3739
US

IV. Provider business mailing address

1805 LAMY LN
MONROE LA
71201-3739
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-5383
  • Fax: 318-388-5779
Mailing address:
  • Phone: 318-388-5383
  • Fax: 318-388-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number018722
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number023401
License Number StateLA

VIII. Authorized Official

Name: MRS. DHAYA N KUTNIKAR
Title or Position: OWNER
Credential: M.D.
Phone: 318-388-5383