Provider Demographics
NPI:1508854894
Name:CHAUDHRY, ILYAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ILYAS
Middle Name:A
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 4TH ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-442-8698
Mailing Address - Fax:318-442-1358
Practice Address - Street 1:201 4TH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-442-8698
Practice Address - Fax:318-442-1358
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06448R207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110067823OtherRAILROAD MEDICARE
LA71301A002OtherTRICARE
MS00125838Medicaid
LA1340855Medicaid
LAB61457Medicare UPIN
MS00125838Medicaid