Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 12869R | LA |
NPI | 1174508741 |
---|---|
Provider Name | Dr. Mudar Kattash |
First Address | Lake Charles, LA 70605 |
Second Address | Lake Charles, LA 70605-4139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1544493 | (05) | LA |
G85148 | (02) |