Organization
HERBERT ICHINOSE, MD APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERBERT ICHINOSE MD (MEDICAL DIRECTOR, OWNER)
(985) 781-9005
Entity
Organization
Contact information
Practice address
1361 ENGLEWOOD DR, SLIDELL, LA 70458-3009
(985) 781-9005
(985) 781-9007
Mailing address
1361 ENGLEWOOD DR, SLIDELL, LA 70458-3009
(985) 781-9005
(985) 781-9007
Taxonomy
Speciality
Code
Description
License number
State
246Q00000X
Pathology Specialist/Technologist
Primary
MD.008092
LA
246QH0600X
Histology Specialist/Technologist
MD.008092
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1107921
—
LA
Enumeration date
05/11/2009
Last updated
05/11/2009
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