MEDICARE: INDIRA SASTRY AND WILLIS-KNIGHTON

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	207RP1001X	Pulmonary Disease Physician

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	:	1972569846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIRA SASTRY AND WILLIS-KNIGHTON

Provider Business Mailing Address
First Line	:	2533 BERT KOUNS LOOP
Second Line	:	SUITE 106
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3158
Country	:	US
Telephone Number	:	318-212-5976
Fax Number	:	318-212-5986

Provider Business Practice Location Address
First Line	:	2533 BERT KOUNS LOOP
Second Line	:	SUITE 106
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3158
Country	:	US
Telephone Number	:	318-212-5976
Fax Number	:	318-212-5986

Authorized Official
Title or Position	:	NETWORK ADMINISTRATOR
Name	:	GREG J. GAVIN
Credential	:
Telephone Number	:	318-212-5976

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	10/01/2013

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Directions to “INDIRA SASTRY AND WILLIS-KNIGHTON ” Practice Location

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