Provider Demographics
NPI:1912535873
Name:AMIDOU, BARISERE (MD)
Entity Type:Individual
Prefix:
First Name:BARISERE
Middle Name:
Last Name:AMIDOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARISERE
Other - Middle Name:
Other - Last Name:BODO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2386
Mailing Address - Country:US
Mailing Address - Phone:318-212-7990
Mailing Address - Fax:318-212-7995
Practice Address - Street 1:2400 HOSPITAL DR STE 130
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2386
Practice Address - Country:US
Practice Address - Phone:318-212-7990
Practice Address - Fax:318-212-7995
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA336760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine