Healthcare Provider Details

I. General information

NPI: 1154244432
Provider Name (Legal Business Name): FNU VISHAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY LSU HEALTH SHREVEPORT, DEPARTMENT OF INTERNAL MEDICINE,
SHREVEPORT LA
71103
US

IV. Provider business mailing address

1501 KINGS HWY LSU HEALTH SHREVEPORT, DEPARTMENT OF INTERNAL MEDICINE,
SHREVEPORT LA
71103
US

V. Phone/Fax

Practice location:
  • Phone: 318-813-1903
  • Fax:
Mailing address:
  • Phone: 318-813-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number352648
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: