Organization
NORTHSHORE ALLERGY & IMMUNOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD JOSEPH GUILLOT MD (OWNER/PRESIDENT)
(985) 792-4022
Entity
Organization
Contact information
Practice address
804 HEAVENS DR, SUITE 203, MANDEVILLE, LA 70471-2890
(985) 792-4022
(985) 792-4007
Mailing address
804 HEAVENS DR, SUITE 203, MANDEVILLE, LA 70471-2890
(985) 792-4022
(985) 792-4007
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD-020599
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1905445
—
LA
Enumeration date
07/18/2007
Last updated
07/18/2007
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