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1396770566

NPI Code Detail

MEDICARE: DR. MARTINA ABENA TAMAKLOE MD

MEDICARE: DR. MARTINA ABENA TAMAKLOE MD

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	E-11439	AR
2	207R00000X	Internal Medicine Physician	35190	LA
3	207R00000X	Internal Medicine Physician	MD.201853	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	:	1396770566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTINA ABENA TAMAKLOE MD

Provider Business Mailing Address
First Line	:	327 JEFFERSON OAKS DR
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-7080
Country	:	US
Telephone Number	:	318-254-3001
Fax Number	:	318-254-2962

Provider Business Practice Location Address
First Line	:	401 E VAUGHN AVE
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-5950
Country	:	US
Telephone Number	:	318-254-2100
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/18/2022

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Directions to “ DR. MARTINA ABENA TAMAKLOE MD” Practice Location

Language	Start Address	Practice Location

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