Provider Demographics
NPI:1679501712
Name:ISMAIL, ANWAR (MD)
Entity Type:Individual
Prefix:
First Name:ANWAR
Middle Name:
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641268
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70064-1268
Mailing Address - Country:US
Mailing Address - Phone:504-464-1021
Mailing Address - Fax:504-464-1022
Practice Address - Street 1:4113 WILLIAMS BLVD.
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-464-1021
Practice Address - Fax:504-464-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11631R2084A0401X, 2084P0804X, 2084P0805X, 2084P0800X
TXK18422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF95849Medicare UPIN
LA1690945Medicare ID - Type Unspecified
LA5Y267Medicare ID - Type Unspecified