Provider Demographics
NPI:1962451815
Name:METABOLIC CENTER OF LOUISIANA
Entity Type:Organization
Organization Name:METABOLIC CENTER OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHUSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-761-7878
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 1004-177
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-763-9050
Mailing Address - Fax:225-763-9335
Practice Address - Street 1:5238 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4311
Practice Address - Country:US
Practice Address - Phone:225-763-9050
Practice Address - Fax:225-763-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07843R207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385956Medicaid
LA1385956Medicaid
LAB83173Medicare UPIN