Provider Demographics
NPI:1437449923
Name:JAIKISHEN, ASHWIN PANNATHPUR (MD)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:PANNATHPUR
Last Name:JAIKISHEN
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 1:4409 UTICA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6579
Mailing Address - Country:US
Mailing Address - Phone:504-457-3687
Mailing Address - Fax:
Practice Address - Street 1:4409 UTICA ST STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6579
Practice Address - Country:US
Practice Address - Phone:504-457-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207430207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology