MEDICARE: CARDIAC AND ENDOVASCULAR SPECIALISTS OF THE SOUTH

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	261QM2500X	Medical Specialty Clinic/Center	MD15664R	LA

General Provider Information

NPI Number	:	1669732780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC AND ENDOVASCULAR SPECIALISTS OF THE SOUTH

Provider Business Mailing Address
First Line	:	2235 HIGHWAY 167
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-1289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10555 LAKE FOREST BLVD
Second Line	:	SUITE 5 JK
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-5206
Country	:	US
Telephone Number	:	313-574-6508
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	KURT ALDRIDGE DUNCAN
Credential	:	MD
Telephone Number	:	313-574-6508

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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