| Indira Gautam Md A Professional Medical Corporation | |
|
327 Iberia St Suite 3a Youngsville LA 70592-6370 | |
| (337) 857-3512 | |
| Not Available |
| Full Name | Indira Gautam Md A Professional Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 327 Iberia St, Youngsville, Louisiana |
| Authorized Official Name and Position | Indira Gautam (OWNER) |
| Authorized Official Contact | 3378573512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indira Gautam Md A Professional Medical Corporation 327 Iberia St Suite 3a Youngsville LA 70592-6370 Ph: (337) 857-3512 | Indira Gautam Md A Professional Medical Corporation 327 Iberia St Suite 3a Youngsville LA 70592-6370 Ph: (337) 857-3512 |
| NPI Number | 1235531989 |
|---|---|
| Provider Enumeration Date | 09/24/2014 |
| Last Update Date | 09/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235531989 | NPI | - | NPPES |
| 1191167 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 15134R (Louisiana) | Primary |
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