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Organization
KSR MEDICAL LLC
Active
Organization
KSR MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHALED MOSTAFA GHORAB MD (OWNER)
(337) 239-4130
Entity
Organization
Contact information
Practice address
1015 W FERTITTA BLVD, LEESVILLE, LA 71446-4646
(337) 239-4130
(337) 238-9030
Mailing address
1015 W FERTITTA BLVD, LEESVILLE, LA 71446-4646
(337) 239-4130
(337) 238-9030
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
202557
LA
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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