Healthcare Provider Details

I. General information

NPI: 1265681621
Provider Name (Legal Business Name): SEKI FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CARTER ST
VIDALIA LA
71373
US

IV. Provider business mailing address

1812 CARTER ST
VIDALIA LA
71373
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-7072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14808R
License Number StateLA

VIII. Authorized Official

Name: IBRAHIM SEKI
Title or Position: PRESIDENT
Credential: MD
Phone: 318-336-7072