Provider Demographics
NPI:1609037225
Name:JOHN KALIEB POURCIAU, DPM, LLC
Entity Type:Organization
Organization Name:JOHN KALIEB POURCIAU, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KALIEB
Authorized Official - Last Name:POURCIAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-546-0740
Mailing Address - Street 1:3521 HIGHWAY 190 EAST
Mailing Address - Street 2:STE U
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5135
Mailing Address - Country:US
Mailing Address - Phone:337-546-0740
Mailing Address - Fax:337-546-0742
Practice Address - Street 1:3521 HIGHWAY 190
Practice Address - Street 2:STE U
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-546-0740
Practice Address - Fax:337-546-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1198501Medicaid
6302280001Medicare NSC
LA1198501Medicaid