Provider Demographics
NPI:1093712028
Name:RAIS, MOHAMMED SAYEEDUR (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:SAYEEDUR
Last Name:RAIS
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 1:1320 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4886
Mailing Address - Country:US
Mailing Address - Phone:985-446-2021
Mailing Address - Fax:985-447-1546
Practice Address - Street 1:1320 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4886
Practice Address - Country:US
Practice Address - Phone:985-446-2021
Practice Address - Fax:985-447-1546
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14182R207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1185965Medicaid
LA1185965Medicaid
LA110225809OtherRR MEDICARE
LA4A4706833Medicare UPIN