Provider Demographics
NPI:1437589447
Name:M V JOHN MD LLC
Entity Type:Organization
Organization Name:M V JOHN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKUS
Authorized Official - Middle Name:VATTAKATTIL
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-263-0600
Mailing Address - Street 1:4021 WE HECK CT STE M1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0405
Mailing Address - Country:US
Mailing Address - Phone:225-263-0600
Mailing Address - Fax:225-231-3047
Practice Address - Street 1:4021 WE HECK CT STE M1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0405
Practice Address - Country:US
Practice Address - Phone:225-263-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty