Organization
NORTHSHORE LASER & VEIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J. GRISOLI M.D. (MEDICAL DIRECTOR)
(985) 507-9116
Entity
Organization
Contact information
Practice address
301 GLORIAS PL, MANDEVILLE, LA 70471-1612
(985) 507-9116
(850) 637-8020
Mailing address
301 GLORIAS PL, MANDEVILLE, LA 70471-1612
(985) 507-9116
(850) 637-8020
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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