Organization
NORTHSHORE INTERNAL MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY B BODEWALDT (OFFICE ADMINISTRATOR)
(985) 318-1000
Entity
Organization
Contact information
Practice address
2101 ROBIN AVE, SUITE 5, HAMMOND, LA 70403-5772
(985) 318-1000
(985) 318-1001
Mailing address
2101 ROBIN AVE, SUITE 5, HAMMOND, LA 70403-5772
(985) 318-1000
(985) 318-1001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1440621
—
LA
Enumeration date
11/01/2006
Last updated
08/22/2020
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