Provider Demographics
NPI:1891156279
Name:INTEGRATIVE MEDICINE OF ACADIANA LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICINE OF ACADIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANJUM
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:800-923-8835
Mailing Address - Street 1:PO BOX 80537
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0537
Mailing Address - Country:US
Mailing Address - Phone:800-923-8835
Mailing Address - Fax:337-593-8330
Practice Address - Street 1:1516 CHEMIN METAIRIE RD
Practice Address - Street 2:SUITE A
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-2000
Practice Address - Country:US
Practice Address - Phone:337-857-5910
Practice Address - Fax:337-857-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty