Provider Demographics
NPI:1659378453
Name:SOBIESK, GEORGE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:SOBIESK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6917
Mailing Address - Country:US
Mailing Address - Phone:337-988-8860
Mailing Address - Fax:337-988-8761
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-988-8860
Practice Address - Fax:337-988-8761
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD186R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1694797Medicaid
LA480035158OtherPALMETTO GBA - RAILROAD M
LA1694797Medicaid
LA0332210001Medicare NSC
LA5Y4667191Medicare PIN