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General NPI Number Information
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NPI Number | 1891510897
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Entity Type | Organization
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Legal Business Name | HEALR CLINIC OF LAFAYETTE LLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 3809 AMBASSADOR CAFFERY PKWY STE 120C
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City | LAFAYETTE
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State | LA
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Zip | 70503-5275
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Country | US
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Telephone | 337-446-4501
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Fax | 337-436-2144
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Provider Business Mailing Address
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Address Line | 3809 AMBASSADOR CAFFERY PKWY STE 120C
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City | LAFAYETTE
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State | LA
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Zip | 70503-5275
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Country | US
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Telephone | 337-446-4501
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Fax | 337-436-2144
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KUNTAL MOHARE
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Credential | MD
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Telephone | 337-446-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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