Provider Demographics
NPI:1982912317
Name:MEDICAL CREATIONS LLC
Entity Type:Organization
Organization Name:MEDICAL CREATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-644-7303
Mailing Address - Street 1:2424 WILLIAMS BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5763
Mailing Address - Country:US
Mailing Address - Phone:646-644-7303
Mailing Address - Fax:
Practice Address - Street 1:2424 WILLIAMS BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5763
Practice Address - Country:US
Practice Address - Phone:646-644-7303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty