Provider Demographics
NPI:1073386520
Name:ALEXANDRIA PEDIATRIC GASTRO, INC
Entity Type:Organization
Organization Name:ALEXANDRIA PEDIATRIC GASTRO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKEREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-256-5722
Mailing Address - Street 1:3311 PRESCOTT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3983
Mailing Address - Country:US
Mailing Address - Phone:318-256-5722
Mailing Address - Fax:318-256-5774
Practice Address - Street 1:3311 PRESCOTT RD STE 210
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3983
Practice Address - Country:US
Practice Address - Phone:318-256-5722
Practice Address - Fax:318-256-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty