Provider Demographics
NPI:1154083376
Name:GRACE GYNECOLOGY & WELLNESS CORP APMC
Entity Type:Organization
Organization Name:GRACE GYNECOLOGY & WELLNESS CORP APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT OF CORP
Authorized Official - Prefix:MS
Authorized Official - First Name:MIKA
Authorized Official - Middle Name:MARLAINE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-654-4729
Mailing Address - Street 1:200 BEAULLIEU DR STE 3B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7230
Mailing Address - Country:US
Mailing Address - Phone:337-522-7282
Mailing Address - Fax:337-393-7057
Practice Address - Street 1:200 BEAULLIEU DR STE 3B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-522-7282
Practice Address - Fax:337-393-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty