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General NPI Number Information
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NPI Number | 1780907782
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Entity Type | Organization
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Legal Business Name | MICHAEL N KLEAMENAKIS
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 4114 MARIGNY ST
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City | NEW ORLEANS
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State | LA
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Zip | 70122-4931
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Country | US
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Telephone | 504-288-2333
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Fax | 504-288-2227
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Provider Business Mailing Address
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Address Line | 4114 MARIGNY ST
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City | NEW ORLEANS
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State | LA
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Zip | 70122-4931
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Country | US
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Telephone | 504-288-2333
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Fax | 504-288-2227
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL KLEAMENAKIS
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Credential | O.D.
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Telephone | 504-288-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 1030-060T
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License Number State | LA
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