Provider Demographics
NPI:1366714669
Name:MEDICINE AND NEPHROLOGY CLINIC OF NEW ORLEANS LLC
Entity type:Organization
Organization Name:MEDICINE AND NEPHROLOGY CLINIC OF NEW ORLEANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NDUBUEZE
Authorized Official - Middle Name:FIDELIS
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-241-6660
Mailing Address - Street 1:5571 READ BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3103
Mailing Address - Country:US
Mailing Address - Phone:504-241-6660
Mailing Address - Fax:504-362-9049
Practice Address - Street 1:5571 READ BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3103
Practice Address - Country:US
Practice Address - Phone:504-241-6660
Practice Address - Fax:504-362-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA09878R207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1972118Medicaid
LA1972118Medicaid
LA5R841Medicare PIN