Provider Demographics
NPI:1942460134
Name:JIWANI, NOOR ALI WALLIMOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:NOOR ALI
Middle Name:WALLIMOHAMMED
Last Name:JIWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NOORALI
Other - Middle Name:W
Other - Last Name:JIWANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2000 OPELOUSAS STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-439-9983
Mailing Address - Fax:337-439-3224
Practice Address - Street 1:2000 OPELOUSAS STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-439-9983
Practice Address - Fax:337-439-3224
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD204690207Q00000X
FLME107815207Q00000X
LAMD.202288207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1082066Medicaid