Provider Demographics
NPI:1831493550
Name:LA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIRANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:TULUMDZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-883-8334
Mailing Address - Street 1:4428 CONLIN ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2124
Mailing Address - Country:US
Mailing Address - Phone:504-883-8334
Mailing Address - Fax:504-883-8336
Practice Address - Street 1:4428 CONLIN ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2124
Practice Address - Country:US
Practice Address - Phone:504-883-8334
Practice Address - Fax:504-883-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty