Provider Demographics
NPI:1053311530
Name:NITSCHE, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:NITSCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4575
Mailing Address - Country:US
Mailing Address - Phone:985-626-5537
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 600B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-454-2191
Practice Address - Fax:504-378-1838
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014479207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1329894Medicaid
LA78820OtherCOVENTRY
LA004080094OtherAETNA
LA5K852Medicare ID - Type Unspecified
LA1329894Medicaid
LA004080094OtherAETNA
LAB61078Medicare UPIN