Provider Demographics
NPI:1497747539
Name:EDWARD ST. MARTIN, JR., M.D., SIDDHARTH K. BHANSALI, M.D., OLLE KJELLG
Entity Type:Organization
Organization Name:EDWARD ST. MARTIN, JR., M.D., SIDDHARTH K. BHANSALI, M.D., OLLE KJELLG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOTTERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-897-9687
Mailing Address - Street 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-897-9687
Mailing Address - Fax:504-899-9351
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-897-9687
Practice Address - Fax:504-899-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793698Medicaid
LA5B953Medicare PIN
LACG9113Medicare PIN