Provider Demographics
NPI:1710269824
Name:AQIB SULTAN MD LLC
Entity Type:Organization
Organization Name:AQIB SULTAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AQIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-649-7070
Mailing Address - Street 1:PO BOX 960428
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:985-649-7070
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:OCHSNER MED CTR - NORTHSHORE
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-649-7070
Practice Address - Fax:405-341-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04388245Medicaid
LA2168754Medicaid
LADS1176OtherRAILROAD MCARE
LA5DV13Medicare PIN