Provider Demographics
NPI:1043405541
Name:KARAYIL THEKKOOTT, NARAYANAN DEEPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:NARAYANAN
Middle Name:DEEPAK
Last Name:KARAYIL THEKKOOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:6550 MAIN STREET
Practice Address - Street 2:STE. 1000
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-654-1559
Practice Address - Fax:225-654-6212
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201962207RC0000X
LA201962207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1120871Medicaid
LA4N1046833Medicare PIN