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General NPI Number Information
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NPI Number | 1598060733
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Entity Type | Organization
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Legal Business Name | HEART CLINIC OF HAMMOND
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 16033 DOCTORS BLVD
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City | HAMMOND
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State | LA
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Zip | 70403-1479
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Country | US
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Telephone | 985-974-9278
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Fax | 985-542-6341
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Provider Business Mailing Address
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Address Line | 16033 DOCTORS BLVD
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City | HAMMOND
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State | LA
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Zip | 70403-1479
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Country | US
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Telephone | 985-974-9278
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Fax | 985-542-6341
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | GHIATH MIKDADI
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Credential | M.D.
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Telephone | 225-270-2733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 11934R
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License Number State | LA
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