Healthcare Provider Details

I. General information

NPI: 1669659983
Provider Name (Legal Business Name): NAHID A ISLAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 OLIVER RD SUITE 1600B
MONROE LA
71201-5702
US

IV. Provider business mailing address

920 OLIVER RD SUITE 1600B
MONROE LA
71201-5702
US

V. Phone/Fax

Practice location:
  • Phone: 318-327-6220
  • Fax:
Mailing address:
  • Phone: 318-327-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12694R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: