Healthcare Provider Details

I. General information

NPI: 1821336405
Provider Name (Legal Business Name): NAUMAN KHALID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CALYPSO ST STE 210
MONROE LA
71201-7551
US

IV. Provider business mailing address

1541 KINGS HWY ATTN: PAYOR CREDENTIALING
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6500
  • Fax: 318-966-6501
Mailing address:
  • Phone: 318-626-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number325085
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number325085
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number325085
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: