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General NPI Number Information
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NPI Number | 1730667973
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Entity Type | Organization
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Legal Business Name | CALCASIEU LUNG AND SLEEP LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 1327 STELLY LN STE 2
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City | SULPHUR
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State | LA
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Zip | 70663-5650
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Country | US
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Telephone | 626-376-2438
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 STELLY LN STE 2
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City | SULPHUR
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State | LA
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Zip | 70663-5650
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Country | US
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Telephone | 626-376-2438
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. KIRAN CHALLAGOLLA
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Credential |
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Telephone | 626-376-2438
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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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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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