Individual
BASSAM G. WANNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
64040 HIGHWAY 434, SUITE 200, LACOMBE, LA 70445-3499
(985) 892-9233
(985) 892-8916
Mailing address
64040 HIGHWAY 434, SUITE 200, LACOMBE, LA 70445-3499
(985) 892-9233
(985) 892-8916
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD.204036
LA
207RC0000X
Cardiovascular Disease Physician
MD.204036
LA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD.204036
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
275915YJC4
GROUP MEMBER PTAN
LA
Enumeration date
06/22/2007
Last updated
04/03/2019
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