Organization
MISS LOU HEALTH LLC
Active
Other names
Miss Lou Cardiology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIKRAMADITYA DULAM M.D. (DOCTOR)
(601) 304-9718
Entity
Organization
Contact information
Practice address
140 JEFFERSON DAVIS BLVD, NATCHEZ, MS 39120-5104
(601) 304-9718
(601) 304-9637
Mailing address
140 JEFFERSON DAVIS BLVD, NATCHEZ, MS 39120-5104
(601) 304-9718
(601) 304-9637
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18344
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02602371
—
MS
01
—
1197785
LOUSISIANA MEDICAID
—
01
—
595597482
BLUE CROSS BLUE SHIELD
MS
Enumeration date
06/11/2006
Last updated
12/21/2020
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