Provider Demographics
NPI:1174732846
Name:ALLAM, MOHAMAD
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:ALLAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOHAMAD
Other - Middle Name:
Other - Last Name:ALLAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:155 HOSPITAL DR #301
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2846
Mailing Address - Country:US
Mailing Address - Phone:337-234-7779
Mailing Address - Fax:337-235-7246
Practice Address - Street 1:155 HOSPITAL DR #301
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2846
Practice Address - Country:US
Practice Address - Phone:337-234-7779
Practice Address - Fax:337-235-7246
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201563208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1021466Medicaid
LA1021466Medicaid