Individual
KWELI JOHARI AMUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2735 HIGHWAY 190, SUITE D, MANDEVILLE, LA 70471-3433
(985) 778-2510
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD.06700R
LA
207R00000X
Internal Medicine Physician
10977
MS
207R00000X
Internal Medicine Physician
Primary
MD.06700R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126584
—
MS
05
—
1352136
—
LA
01
—
4274592
AETNA
MS
01
—
P00808485
RAILROAD MEDICARE PTAN
MS
Enumeration date
01/24/2007
Last updated
04/26/2017
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