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NPI Code Detail

MEDICARE: DR. JOHN MATHEW EDAVETTAL M.D.

MEDICARE: DR. JOHN MATHEW EDAVETTAL 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
1207RC0000XCardiovascular Disease Physician021589LA
2207RI0011XInterventional Cardiology Physician021589LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558333617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN MATHEW EDAVETTAL M.D.
Provider Business Mailing Address
First Line : 441 HEYMANN BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-2611
Country : US
Telephone Number : 337-289-8429
Fax Number : 337-289-8431
Provider Business Practice Location Address
First Line : 441 HEYMANN BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-2611
Country : US
Telephone Number : 337-289-8429
Fax Number : 337-289-8431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 05/23/2019

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