Healthcare Provider Details

I. General information

NPI: 1275830655
Provider Name (Legal Business Name): MD2U LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2011
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT CHARLES AVE STE. 2500
NEW ORLEANS LA
70170-1000
US

IV. Provider business mailing address

PO BOX 7219
LOUISVILLE KY
40257-0219
US

V. Phone/Fax

Practice location:
  • Phone: 866-460-3567
  • Fax: 502-742-3767
Mailing address:
  • Phone: 502-327-9410
  • Fax: 502-742-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY D LATTA
Title or Position: CIO
Credential:
Phone: 502-416-1851