MEDICARE: ELIZABETH ROURKE D.O, MPH

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	208800000X	Urology Physician	326493	LA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	326493	LA

General Provider Information

NPI Number	:	1609296649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ROURKE D.O, MPH

Provider Business Mailing Address
First Line	:	3601 HOUMA BLVD STE 302
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-4310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 HOUMA BLVD STE 302
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-4310
Country	:	US
Telephone Number	:	504-412-1600
Fax Number	:

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

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	05/11/2023

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