Individual
LAKISAH BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
175 HECTOR AVE, GRETNA, LA 70056-2590
(504) 349-6925
(504) 362-5310
Mailing address
175 HECTOR AVE, GRETNA, LA 70056-2590
(504) 349-6925
(504) 362-5310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
203411
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002224
—
LA
Enumeration date
04/23/2008
Last updated
01/31/2014
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