Organization
RADOVI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANMUGANATHAN SHANTHA M.D (DIRECT OWNER)
(504) 914-2908
Entity
Organization
Contact information
Practice address
7153 EDGEWATER DR, MANDEVILLE, LA 70471-7431
(504) 914-2908
(985) 674-4390
Mailing address
7153 EDGEWATER DR, MANDEVILLE, LA 70471-7431
(504) 914-2908
(985) 674-4390
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
15098R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1422029
—
LA
Enumeration date
10/02/2012
Last updated
10/02/2012
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