Provider Demographics
NPI:1669675054
Name:WILLCARE, LLC
Entity Type:Organization
Organization Name:WILLCARE, LLC
Other - Org Name:STEPHEN J. DELATTE, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELATTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-269-4949
Mailing Address - Street 1:100 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5702
Mailing Address - Country:US
Mailing Address - Phone:337-269-4949
Mailing Address - Fax:337-269-4950
Practice Address - Street 1:100 DRURY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5702
Practice Address - Country:US
Practice Address - Phone:337-269-4949
Practice Address - Fax:337-269-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2005122086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1590347Medicaid
LA1590347Medicaid