MEDICARE: MEDICINE AND NEPHROLOGY CLINIC OF NEW ORLEANS LLC

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	207RN0300X	Nephrology Physician	LA09878R	LA
2	207R00000X	Internal Medicine Physician	LA09878R	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

General Provider Information

NPI Number	:	1366714669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE AND NEPHROLOGY CLINIC OF NEW ORLEANS LLC

Provider Business Mailing Address
First Line	:	5571 READ BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-3103
Country	:	US
Telephone Number	:	504-241-6660
Fax Number	:	504-362-9049

Provider Business Practice Location Address
First Line	:	5571 READ BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-3103
Country	:	US
Telephone Number	:	504-241-6660
Fax Number	:	504-362-9049

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NDUBUEZE FIDELIS OKONKWO
Credential	:	M.D.
Telephone Number	:	504-241-6660

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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