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General NPI Number Information
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NPI Number | 1013200716
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF HAMMOND, LLC
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 1004 W THOMAS ST
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City | HAMMOND
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State | LA
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Zip | 70401-3040
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Country | US
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Telephone | 985-230-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 W THOMAS ST
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City | HAMMOND
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State | LA
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Zip | 70401-3040
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Country | US
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Telephone | 985-230-4466
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANGELO RUSSO
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Credential | M.D.
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Telephone | 985-230-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.014788
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License Number State | LA
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