Organization
ROBERT L. MIMELES, MD, APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT L. MIMELES MD (PRESIDENT)
(504) 885-8225
Entity
Organization
Contact information
Practice address
4720 S I 10 SERVICE RD W, SUITE 301, METAIRIE, LA 70001-7404
(504) 885-8225
Mailing address
4720 S I 10 SERVICE RD W, SUITE 301, METAIRIE, LA 70001-7404
(504) 885-8225
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
011441
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1156442
—
LA
01
—
173236100
DOL
LA
01
—
DH0323
MEDICARE RR
LA
01
—
H9832
BLUE CROSS BLUE SHIELD
LA
Enumeration date
01/16/2008
Last updated
05/13/2008
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