Healthcare Provider Details

I. General information

NPI: 1942537378
Provider Name (Legal Business Name): GAYATRI MIRANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 TULANE AVE 500
NEW ORLEANS LA
70119-7462
US

IV. Provider business mailing address

2601 TULANE AVE 500
NEW ORLEANS LA
70119-7462
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-2601
  • Fax: 504-267-3014
Mailing address:
  • Phone: 504-821-2601
  • Fax: 504-267-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD.205830
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: