Healthcare Provider Details

I. General information

NPI: 1437238656
Provider Name (Legal Business Name): MISTY SURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4000
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD025766
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number025766
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: