Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 309907 | LA |
NPI | 1518354224 |
---|---|
Provider Name | Dr. Sasikumar Kilaikode Cheruveettara |
First Address | Shreveport, LA 71115-3861 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 04/05/2019 |