Provider Demographics
NPI:1841325206
Name:MEDICAL ARTS ADULT AND PEDIATRIC UROLOGY, LLC
Entity type:Organization
Organization Name:MEDICAL ARTS ADULT AND PEDIATRIC UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONADELVERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-542-1317
Mailing Address - Street 1:42421 PELICAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2405
Mailing Address - Country:US
Mailing Address - Phone:985-542-1317
Mailing Address - Fax:985-542-1958
Practice Address - Street 1:42421 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2405
Practice Address - Country:US
Practice Address - Phone:985-542-1317
Practice Address - Fax:985-542-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443298Medicaid
LA5CB13Medicare ID - Type Unspecified