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NPI Code Detail

MEDICARE: NORTHWEST LOUISIANA NEPHROLOGY, LLC

MEDICARE: NORTHWEST LOUISIANA NEPHROLOGY, 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
1207RN0300XNephrology Physician

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 : 1669416491
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST LOUISIANA NEPHROLOGY, LLC
Provider Business Mailing Address
First Line : 1800 BUCKNER ST STE C120
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4453
Country : US
Telephone Number : 318-227-8899
Fax Number : 318-222-0407
Provider Business Practice Location Address
First Line : 1800 BUCKNER ST
Second Line : SUITE C120
City : SHREVEPORT
State : LA
Zip : 71101-4440
Country : US
Telephone Number : 318-227-8899
Fax Number : 318-222-0407
Authorized Official
Title or Position : MD
Name : SREEDHARA B ALLA
Credential :
Telephone Number : 318-227-8899
Provider Enumeration Date : 06/15/2006
Last Update Date : 03/12/2026

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1477548030 — DR. PHILIP J GARAVAGLIA MD
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1154317469 — DR. MICHAEL D ROKAW MD
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Directions to “NORTHWEST LOUISIANA NEPHROLOGY, LLC ” Practice Location

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