MEDICARE: DR. GHAYAS AHMED QURESHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD11742R	LA
2	207P00000X	Emergency Medicine Physician	11742R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	255840YJ9R	OTHER		PTAN

General Provider Information

NPI Number	:	1114923901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHAYAS AHMED QURESHI M.D.

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 CROWLEY RAYNE HWY
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526
Country	:	US
Telephone Number	:	337-783-3222
Fax Number	:	337-788-6413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2005
Last Update Date	:	08/21/2019

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