Healthcare Provider Details

I. General information

NPI: 1023197142
Provider Name (Legal Business Name): UJWAL MEKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 COOPER RD STE 100
PICAYUNE MS
39466-2835
US

IV. Provider business mailing address

1375 CORPORATE SQUARE DR
SLIDELL LA
70458-3147
US

V. Phone/Fax

Practice location:
  • Phone: 769-242-1700
  • Fax: 769-242-2148
Mailing address:
  • Phone: 985-649-1152
  • Fax: 985-649-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.200296
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number25550
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: