Provider Demographics
NPI:1609167501
Name:BAYOU PULMONARY LLC
Entity Type:Organization
Organization Name:BAYOU PULMONARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-220-3831
Mailing Address - Street 1:5321 COCOS PLUMOSAS DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2320
Mailing Address - Country:US
Mailing Address - Phone:504-220-3831
Mailing Address - Fax:504-456-7453
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-456-7456
Practice Address - Fax:504-456-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019956207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty