Organization
DESTREHAN MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHEMMALE JAYAKRISHNAN (PRESIDENT/DOCTOR)
(985) 785-2045
Entity
Organization
Contact information
Practice address
12604 RIVER RD, DESTREHAN, LA 70047-5306
(985) 764-0439
(985) 725-1464
Mailing address
12604 RIVER RD, DESTREHAN, LA 70047-5306
(985) 764-0439
(985) 725-1464
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1798703
—
LA
Enumeration date
09/28/2006
Last updated
07/21/2022
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