Basic Information
| Provider Information | |||||||||
| NPI: | 1386890200 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUBEDEE | ||||||||
| FirstName: | ANUP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 FLORIDA BLVD. | ||||||||
| Address2: | C/O HMG PHYSICIANS, LLC | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253877070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3600 FLORIDA BLVD | ||||||||
| Address2: | C/O HMG PHYSICIANS, LLC | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253877070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | MD.205668 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 2193210 | 05 | LA | MEDICAID |