Healthcare Provider Details

I. General information

NPI: 1710218698
Provider Name (Legal Business Name): VIPUL SHELAT APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2010
Last Update Date: 01/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRAMMONT ST #400B
MONROE LA
71201-7457
US

IV. Provider business mailing address

312 GRAMMONT ST #400B
MONROE LA
71201-7457
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-1901
  • Fax:
Mailing address:
  • Phone: 318-324-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number13324R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number13324R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number13324R
License Number StateLA

VIII. Authorized Official

Name: DR. VIPUL SHELAT
Title or Position: OWNER
Credential: MBBS
Phone: 318-324-1901