Organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Active
Parent organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Other names
Lake Physician Group Cardiology Ser
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Authorized official
ELONA SHARBAUGH (VP PHYSICIAN PRACTICES)
(225) 765-8680
Entity
Organization
Contact information
Practice address
8415 GOODWOOD BLVD, STE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-4278
Mailing address
8415 GOODWOOD BLVD, STE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-4278
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
11/24/2010
Last updated
11/24/2010
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