Provider Demographics
NPI:1659444701
Name:REDLICH, GILLIAN (MD)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:REDLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 ANDRE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2159
Mailing Address - Country:US
Mailing Address - Phone:337-365-5944
Mailing Address - Fax:337-364-4377
Practice Address - Street 1:1100 ANDRE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-365-5944
Practice Address - Fax:337-364-4377
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.022349207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438774Medicaid
LA1438774Medicaid
LA$$$$$$$$$AOtherBCBS OF LOUISIANA
H29883Medicare UPIN