MEDICARE: PERVEZ MUSSARAT 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	174400000X	Specialist	08635R	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	0565390002	OTHER	LA	CIGNA
3	691600	OTHER	LA	AETNA

General Provider Information

NPI Number	:	1134121999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERVEZ MUSSARAT M.D.

Provider Business Mailing Address
First Line	:	15784 MEDICAL ARTS DR
Second Line	:	SUITE A
City	:	HAMMOND
State	:	LA
Zip	:	70403-1446
Country	:	US
Telephone Number	:	985-542-9441
Fax Number	:	985-542-9414

Provider Business Practice Location Address
First Line	:	15784 MEDICAL ARTS DR
Second Line	:	SUITE A
City	:	HAMMOND
State	:	LA
Zip	:	70403-1446
Country	:	US
Telephone Number	:	985-542-9441
Fax Number	:	985-542-9414

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/12/2009

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