Organization
IMPERIAL HEALTH LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRIS HICKINGBOTTOM (CEO)
(337) 433-8400
Entity
Organization
Contact information
Practice address
4150 NELSON RD, SUITE E 1, LAKE CHARLES, LA 70605-4148
(337) 433-8400
Mailing address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 433-8400
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
015309
LA
Other
Enumeration date
10/23/2012
Last updated
04/15/2013
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