Healthcare Provider Details

I. General information

NPI: 1053352328
Provider Name (Legal Business Name): ANTTI G MARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CALYPSO STREET; SUITE 210
MONROE LA
71201
US

IV. Provider business mailing address

411 CALYPSO STREET; SUITE 210
MONROE LA
71201
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04712R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: