Organization
PELICAN PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KUMAR KISHORE AMARANENI M.D (OWNER/REGISTERED AGENT)
(985) 645-9000
Entity
Organization
Contact information
Practice address
2375 GAUSE BLVD E, SLIDELL, LA 70461-4142
(985) 645-9000
(985) 645-0359
Mailing address
2375 GAUSE BLVD E, SLIDELL, LA 70461-4142
(985) 645-9000
(985) 645-0359
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
06512R
LA
207Q00000X
Family Medicine Physician
019740
LA
207R00000X
Internal Medicine Physician
025659
LA
208000000X
Pediatrics Physician
025659
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1442119
—
LA
Enumeration date
09/23/2010
Last updated
07/09/2014
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