| Abaka LLC | |
|
3050 Baird Rd Shreveport LA 71118-3818 | |
| (318) 688-1010 | |
| Not Available |
| Full Name | Abaka LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3050 Baird Rd, Shreveport, Louisiana |
| Authorized Official Name and Position | Allan Matriano Lim (MEMBER) |
| Authorized Official Contact | 3185880880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abaka LLC Po Box 1684 Shreveport LA 71165-1684 Ph: (318) 424-4008 | Abaka LLC 3050 Baird Rd Shreveport LA 71118-3818 Ph: (318) 688-1010 |
| NPI Number | 1477106524 |
|---|---|
| Provider Enumeration Date | 07/18/2019 |
| Last Update Date | 07/18/2019 |
| Medicare PECOS PAC ID | 9234460973 |
|---|---|
| Medicare Enrollment ID | O20191011000296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477106524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Michael a Angelo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295723955 PECOS PAC ID: 9133158827 Enrollment ID: I20050812000266 |
| Provider Name | Allan S Matriano-lim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649268590 PECOS PAC ID: 1456455062 Enrollment ID: I20070409000158 |
| Provider Name | Alexandra Jones Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700166717 PECOS PAC ID: 1759551344 Enrollment ID: I20110909002805 |
| Provider Name | Chequan Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821375932 PECOS PAC ID: 7618142019 Enrollment ID: I20111214000242 |
| Provider Name | Brandi Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659677540 PECOS PAC ID: 7416108691 Enrollment ID: I20121116000188 |
| Provider Name | Lisa Wilhite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265047013 PECOS PAC ID: 7719331479 Enrollment ID: I20230928002262 |
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