Organization
PREM MENON MD A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIMLA MENON M.D (CO-OWNER)
(225) 766-6931
Entity
Organization
Contact information
Practice address
5217 FLANDERS DR, BATON ROUGE, LA 70808-9169
(225) 766-6931
(225) 766-9413
Mailing address
5217 FLANDERS DR, BATON ROUGE, LA 70808-9169
(225) 766-6931
(225) 766-9413
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
07041R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1904953
—
LA
Enumeration date
12/27/2010
Last updated
12/27/2010
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