Basic Information
| Provider Information | |||||||||
| NPI: | 1346741022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADE FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2014 MAGAZINE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701305018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045295558 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 SAINT ANDREW ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701305022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045295558 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2018 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | ERWIN | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5045295558 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.