Provider Demographics
NPI:1801874458
Name:DIABETES & METABOLISM ASSOC APMC
Entity type:Organization
Organization Name:DIABETES & METABOLISM ASSOC APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-737-5960
Mailing Address - Street 1:501 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1172
Mailing Address - Country:US
Mailing Address - Phone:504-737-5960
Mailing Address - Fax:504-737-1480
Practice Address - Street 1:3901 HOUMA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-455-1300
Practice Address - Fax:504-780-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4D007Medicare ID - Type Unspecified