Healthcare Provider Details

I. General information

NPI: 1316133903
Provider Name (Legal Business Name): FIKRE S. WANG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 PRYTANIA ST SUITE 65
NEW ORLEANS LA
70115-3628
US

IV. Provider business mailing address

1302 MARENGO ST UNIT A
NEW ORLEANS LA
70115-3813
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-4744
  • Fax: 504-899-4745
Mailing address:
  • Phone: 504-899-4744
  • Fax: 504-899-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.200720
License Number StateLA

VIII. Authorized Official

Name: DR. FIKRE S WANG
Title or Position: DIRECTOR
Credential: M.D.
Phone: 504-899-4744