Provider Demographics
NPI:1700806049
Name:NAGEM, EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:NAGEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BLDG 14A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6984
Mailing Address - Country:US
Mailing Address - Phone:337-470-2296
Mailing Address - Fax:337-470-2019
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BLDG 14A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-470-3580
Practice Address - Fax:337-470-3586
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA780002059OtherRR MEDICARE
LA1197505Medicaid
LA5L6606751Medicare PIN
LA780002059OtherRR MEDICARE