Provider Demographics
NPI:1063822997
Name:ACADIANA ID ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ACADIANA ID ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VITALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:337-534-4131
Mailing Address - Street 1:PO BOX 81247
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1247
Mailing Address - Country:US
Mailing Address - Phone:337-534-4131
Mailing Address - Fax:337-385-5859
Practice Address - Street 1:1700 KALISTE SALOOM RD BLDG 6
Practice Address - Street 2:SUITE 600
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6112
Practice Address - Country:US
Practice Address - Phone:337-534-4131
Practice Address - Fax:337-385-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15601R207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty