Provider Demographics
NPI:1073578233
Name:AHMAD MANOUCHEHRI MD APMC
Entity Type:Organization
Organization Name:AHMAD MANOUCHEHRI MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOUCHEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-342-4708
Mailing Address - Street 1:1340 POYDRAS ST
Mailing Address - Street 2:SUITE 1850
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-342-4708
Mailing Address - Fax:504-679-9928
Practice Address - Street 1:15799 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1452
Practice Address - Country:US
Practice Address - Phone:985-345-5621
Practice Address - Fax:985-345-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1307513Medicaid
LA1307513Medicaid