Provider Demographics
NPI:1841267598
Name:SULTAN, AQIB (MD)
Entity type:Individual
Prefix:
First Name:AQIB
Middle Name:
Last Name:SULTAN
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-649-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200233207R00000X
LAMD200233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628573Medicaid
LAP00865240OtherRRMCARE
LAP00996840OtherRAILROAD MCARE
MSP00817315OtherRAILROAD MCARE THRU HCCN
MS00204318Medicaid
LAP00993210OtherRRMCARE THRU IMC
MSP00743847OtherMEDICARE RR
LA4J780Medicare PIN
MSP00743847OtherMEDICARE RR
MS00204318Medicaid
LA4J7807061Medicare PIN
MS302I111476Medicare PIN
LAI36063Medicare UPIN
LAP00996840OtherRAILROAD MCARE