Basic Information
| Provider Information | |||||||||
| NPI: | 1073578233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHMAD MANOUCHEHRI MD APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 POYDRAS ST | ||||||||
| Address2: | SUITE 1850 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701121221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043424708 | ||||||||
| FaxNumber: | 5046799928 | ||||||||
| Practice Location | |||||||||
| Address1: | 15799 PROFESSIONAL PLZ | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704031452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853455621 | ||||||||
| FaxNumber: | 9853455622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANOUCHEHRI | ||||||||
| AuthorizedOfficialFirstName: | AHMAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5043424708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1307513 | 05 | LA | MEDICAID |