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General NPI Number Information
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NPI Number | 1295050599
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Entity Type | Organization
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Legal Business Name | NORTHSHORE REDI-MED LLC
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 4430 HWY 22
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City | MANDEVILLE
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State | LA
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Zip | 70471
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Country | US
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Telephone | 985-626-3470
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Fax | 985-674-5377
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Provider Business Mailing Address
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Address Line | 4430 HWY 22
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City | MANDEVILLE
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State | LA
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Zip | 70471
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Country | US
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Telephone | 985-626-3470
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Fax | 985-674-5377
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMAD NAEEM
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Credential | AO
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Telephone | 985-626-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10199R
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License Number State | LA
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