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General NPI Number Information
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NPI Number | 1174238752
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Entity Type | Organization
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Legal Business Name | DIABETIC CARE CENTERS OF LOUISIANA INC
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 7659 GILBERT ST. SUITE D
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City | GILBERT
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State | LA
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Zip | 71336
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Country | US
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Telephone | 318-657-1220
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Fax | 318-367-1376
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Provider Business Mailing Address
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Address Line | 7659 GILBERT ST. SUITE D
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City | GILBERT
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State | LA
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Zip | 71336-3427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MICHAEL SHANE DAVIDSON
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Credential |
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Telephone | 318-512-1176
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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 |
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License Number State |
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