Individual
ADITYA BAMBORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 330-7600
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
82886
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2023
Last updated
04/24/2026
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