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General NPI Number Information
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NPI Number | 1770709404
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Entity Type | Organization
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Legal Business Name | NORTHLAKE RHEUMATOLOGY, PMLLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 15752 MEDICAL ARTS DR STE. 100
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City | HAMMOND
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State | LA
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Zip | 70403-1446
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Country | US
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Telephone | 985-340-7900
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Fax | 985-340-0944
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Provider Business Mailing Address
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Address Line | 15752 MEDICAL ARTS DR STE. 100
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City | HAMMOND
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State | LA
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Zip | 70403-1446
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Country | US
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Telephone | 985-340-7900
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Fax | 985-340-0944
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Authorized Official
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Title or Position | PHYICIAN
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Name | DR. MALIK C SPADY
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Credential | MD
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Telephone | 985-340-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 025536
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License Number State | LA
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