Provider Demographics
NPI:1295269876
Name:LAKE PELICAN, APMC
Entity type:Organization
Organization Name:LAKE PELICAN, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-464-1021
Mailing Address - Street 1:4113 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2202
Mailing Address - Country:US
Mailing Address - Phone:504-464-1021
Mailing Address - Fax:504-464-1022
Practice Address - Street 1:4113 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2202
Practice Address - Country:US
Practice Address - Phone:504-464-1021
Practice Address - Fax:504-464-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty