Provider Demographics
NPI:1770709404
Name:NORTHLAKE RHEUMATOLOGY, PMLLC
Entity type:Organization
Organization Name:NORTHLAKE RHEUMATOLOGY, PMLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-340-7900
Mailing Address - Street 1:15752 MEDICAL ARTS DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1446
Mailing Address - Country:US
Mailing Address - Phone:985-340-7900
Mailing Address - Fax:985-340-0944
Practice Address - Street 1:15752 MEDICAL ARTS DR
Practice Address - Street 2:STE. 100
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1446
Practice Address - Country:US
Practice Address - Phone:985-340-7900
Practice Address - Fax:985-340-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025536207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty