MEDICARE: ST LUKE'S MEDICAL GROUP OF LOUISIANA, 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
1	207R00000X	Internal Medicine Physician	303032	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	:	1922504364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKE'S MEDICAL GROUP OF LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	10473 OLD HAMMOND HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8264
Country	:	US
Telephone Number	:	225-924-1910
Fax Number	:	225-924-1988

Provider Business Practice Location Address
First Line	:	3955 GOVERNMENT ST STE 2
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-5755
Country	:	US
Telephone Number	:	225-924-1910
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OPERATIONS
Name	:	WENDY CHAPMAN
Credential	:
Telephone Number	:	225-900-8923

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/22/2026

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