Provider Demographics
NPI:1326020330
Name:SYED, EHTESHAM U (MD)
Entity Type:Individual
Prefix:
First Name:EHTESHAM
Middle Name:U
Last Name:SYED
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 1:324 W HALE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8439
Mailing Address - Country:US
Mailing Address - Phone:337-433-9177
Mailing Address - Fax:337-433-9173
Practice Address - Street 1:324 W HALE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8439
Practice Address - Country:US
Practice Address - Phone:337-433-9177
Practice Address - Fax:337-433-9173
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14977R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1153249Medicaid
4F073Medicare ID - Type Unspecified
LA1153249Medicaid