Individual
MYDHILI KANUMILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
2647 S SAINT ELIZABETH BLVD, GONZALES, LA 70737-5021
(225) 647-8511
(225) 644-5213
Mailing address
2647 S SAINT ELIZABETH BLVD, GONZALES, LA 70737-5021
(225) 647-8511
(225) 644-5213
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD207526
LA
Other
Enumeration date
09/21/2011
Last updated
04/23/2015
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