Provider Demographics
NPI:1396461653
Name:NORTHLAKE CARDIOLOGY AND WELLCARE CENTER
Entity type:Organization
Organization Name:NORTHLAKE CARDIOLOGY AND WELLCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-451-5934
Mailing Address - Street 1:804 HEAVENS DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2890
Mailing Address - Country:US
Mailing Address - Phone:985-807-1133
Mailing Address - Fax:
Practice Address - Street 1:804 HEAVENS DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2890
Practice Address - Country:US
Practice Address - Phone:985-807-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty