Individual
MR. CYRIL VK BETHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1051 GAUSE BLVD., SUITE 230, SLIDELL, LA 70458
(985) 641-7577
(985) 643-0826
Mailing address
4507 15TH STREET, GULFPORT, MS 39501
(228) 863-9999
(228) 863-9955
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
16691
MS
207RC0000X
Cardiovascular Disease Physician
MD.13606R
LA
207RI0011X
Interventional Cardiology Physician
Primary
13606R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121860
—
MS
01
—
P00788878
RAILROAD MEDICARE
MS
Enumeration date
08/30/2006
Last updated
04/13/2023
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