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General NPI Number Information
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NPI Number | 1326220955
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Entity Type | Organization
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Legal Business Name | NEUROLOGY & HEADACHE CENTER INC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 3555 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-2119
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Country | US
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Telephone | 318-865-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 3555 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-2119
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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
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Name | DR. SURESH KUMAR
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Credential |
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Telephone | 318-865-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | MD204501
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License Number State | LA
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