Provider Demographics
NPI:1275569485
Name:ZEIK, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:ZEIK
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 1:300 W SAINT MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4638
Mailing Address - Country:US
Mailing Address - Phone:337-233-6593
Mailing Address - Fax:337-235-1032
Practice Address - Street 1:300 W SAINT MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4638
Practice Address - Country:US
Practice Address - Phone:337-233-6593
Practice Address - Fax:337-235-1032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06475R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358177Medicaid
LA1358177Medicaid
LAB62919Medicare UPIN