Provider Demographics
NPI:1023231628
Name:NILESHWAR, RAMGOPAL S (MA, CCC-A, FAAA)
Entity type:Individual
Prefix:MR
First Name:RAMGOPAL
Middle Name:S
Last Name:NILESHWAR
Suffix:
Gender:M
Credentials:MA, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 W SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6755
Mailing Address - Country:US
Mailing Address - Phone:337-478-6987
Mailing Address - Fax:337-474-6890
Practice Address - Street 1:1919A SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4132
Practice Address - Country:US
Practice Address - Phone:337-474-3880
Practice Address - Fax:337-474-6890
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1676237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1553085Medicaid
5X788Medicare UPIN