Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N5210 | TX |
Y | 2080P0202X | Pediatric Cardiologist | MD.205586 | LA |
N | 2080P0202X | Pediatric Cardiologist | N5210 | TX |
NPI | 1134442049 |
---|---|
Provider Name | Scott Lawrence Macicek |
First Address | New Orleans, LA 70121-2406 |
Second Address | New Orleans, LA 70121-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2010 |
Last Update Date | 21/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08333210 | (05) | MS |
2306367 | (05) | LA |