Healthcare Provider Details

I. General information

NPI: 1285866947
Provider Name (Legal Business Name): JAMES SCOTT KRULISKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9751
  • Fax: 504-896-3952
Mailing address:
  • Phone: 504-896-9751
  • Fax: 504-896-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number207779
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: