Provider Demographics
NPI:1477927838
Name:SMART SINUS AND ALLERGY LOUISIANA LLC
Entity Type:Organization
Organization Name:SMART SINUS AND ALLERGY LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-278-1885
Mailing Address - Street 1:73100 E STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1008
Mailing Address - Country:US
Mailing Address - Phone:847-278-1885
Mailing Address - Fax:630-635-2496
Practice Address - Street 1:73100 E STADIUM DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1008
Practice Address - Country:US
Practice Address - Phone:847-278-1885
Practice Address - Fax:630-635-2496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMART SINUS AND ALLERGY LOUISIANA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-23
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300201207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty