Individual
BENEDICT AMALRAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
328085
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301115970
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
06/19/2018
Last updated
03/14/2023
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