Provider Demographics
NPI:1417167750
Name:JOHN, MARKUS VATTAKATTIL (MD)
Entity Type:Individual
Prefix:
First Name:MARKUS
Middle Name:VATTAKATTIL
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:VATTAKATTIL
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4021 WE HECK CT
Mailing Address - Street 2:BUILDING M-1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0416
Mailing Address - Country:US
Mailing Address - Phone:225-263-0600
Mailing Address - Fax:225-263-0601
Practice Address - Street 1:4021 WE HECK CT
Practice Address - Street 2:BUILDING M-1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0416
Practice Address - Country:US
Practice Address - Phone:225-263-0600
Practice Address - Fax:225-263-0601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2021522081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine