Provider Demographics
NPI:1407067820
Name:WESTSIDE EAR, NOSE & THROAT
Entity Type:Organization
Organization Name:WESTSIDE EAR, NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-687-4477
Mailing Address - Street 1:59325 RIVER WEST DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764
Mailing Address - Country:US
Mailing Address - Phone:225-687-4477
Mailing Address - Fax:225-687-9797
Practice Address - Street 1:59325 RIVER WEST DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764
Practice Address - Country:US
Practice Address - Phone:225-687-4477
Practice Address - Fax:225-687-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1974382Medicaid
LA1974382Medicaid
LAF68458Medicare UPIN