Provider Demographics
NPI:1821420514
Name:LOUISIANA INFECTIOUS DISEASES CONSULTANT, LLC
Entity Type:Organization
Organization Name:LOUISIANA INFECTIOUS DISEASES CONSULTANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFECTIOUS DISEASES
Authorized Official - Prefix:DR
Authorized Official - First Name:HALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOU FAYCAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-210-7139
Mailing Address - Street 1:11010 HELENS WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-9328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11010 HELENS WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-9328
Practice Address - Country:US
Practice Address - Phone:318-210-7139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD205782207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty