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Individual

DR. BLAISE ANDREW ANGELICO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4228 HOUMA BLVD, STE 400, METAIRIE, LA 70006-3000
(504) 456-5123
(504) 456-5129
Mailing address
4300 HOUMA BLVD, SUITE 202, METAIRIE, LA 70006-2932
(504) 883-3700
(504) 883-3710

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD014132
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1199508
LA
01
5M214
MEDICARE PTAN
LA
Enumeration date
05/17/2006
Last updated
12/21/2012
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