# M A CULASSO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083617237
- **Authorized official:** MR. MIGUEL A CULASSO MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (985) 646-0945

## Contact information

- **Practice address:** 1520 GAUSE BLVD, SLIDELL, LA 70458-2208
- **Practice address phone:** (985) 649-0945
- **Practice address fax:** (985) 643-8510
- **Mailing address:** PO BOX 729, SLIDELL, LA 70459-0729
- **Mailing address phone:** (985) 646-0945
- **Mailing address fax:** (985) 643-8510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 013032 | LA | Yes |

## Other

- **Enumeration date:** 05/23/2005
- **Last updated:** 04/05/2011