Provider Demographics
NPI:1245242023
Name:PEDIATRIC CARDIOLOGY ASSOCIATES OF LOUISIANA, INC.
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES OF LOUISIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SANDERS
Authorized Official - Last Name:CRAPANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-767-6700
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-767-6700
Mailing Address - Fax:225-767-6721
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-767-6700
Practice Address - Fax:225-767-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D733Medicare ID - Type Unspecified