Provider Demographics
NPI:1134116189
Name:MINARDI, ANDREW J JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MINARDI
Suffix:JR
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 1:809 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2223
Mailing Address - Country:US
Mailing Address - Phone:337-468-5399
Mailing Address - Fax:888-317-2910
Practice Address - Street 1:809 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2223
Practice Address - Country:US
Practice Address - Phone:337-468-5399
Practice Address - Fax:888-317-2910
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022318208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495077Medicaid
LA5A796Medicare PIN
LA1495077Medicaid